Urological Complications After Renal Transplantation

Renal Transplant Complications: Diagnostic and Therapeutic Role of Radiology

Kidney was the first and is the most frequently transplanted organ. Despite improved surgical techniques and transplantation technology, complications do occur and, if left untreated, may lead to catastrophic consequences. Renal transplantation complications may be vascular (eg, renal artery and vein stenosis and thrombosis, arteriovenous fistula, and pseudoaneurysms); urologic (eg, urinary obstruction and leak, and peritransplantation fluid collections, including hematoma, seroma, lymphocele, and abscess formation); and nephrogenic, including acute tubular necrosis, graft rejection, chronic allograft nephropathy, and neoplasm. Early diagnosis and treatment of these complications are paramount to prevent graft failure and other significant morbidities to the patients. Radiology plays a pivotal role in the diagnosis and treatment of these complications, with minimally invasive percutaneous techniques. In this article, we reviewed renal transplantation anatomy, a wide range of complications that may occur after renal transplantation surgery, typical imaging appearances of the complications on varies imaging modalities, and percutaneous interventional techniques that are used in their treatment.

Imaging in Renal Transplantation

Renal transplantation is the best treatment option for chronic renal failure, with marked improvement in social activity, work, and family life. In addition to these obvious improvements, it is an extremely cost-effective procedure when successful. Ultrasonography plays a major role in the imaging of these patients, and ultrasound (including color Doppler) is helpful to the transplant physician in detecting graft dysfunction and peritransplant collections, some of which may be drained under ultrasound guidance. It is also helpful in the diagnosis of chronic vascular complications including transplant artery stenosis and arteriovenous fistula. It has no specific application in the diagnosis of chronic rejection.

Ultrasound of renal transplantation

The most effective primary treatment of chronic renal failure is renal transplantation. A significant improvement in lifestyle and family life in conjunction with it being an extremely cost-effective procedure has resulted in an intense monitoring and imaging programme to help ensure a successful outcome. Ultrasound, both grey-scale and colour-flow Doppler, are useful monitoring techniques when interpreted in the clinical context, and in the delineation of peri-transplant collections, some of which can be drained under ultrasound guidance. After the early post-operative period it can also be utilized in the diagnosis of chronic vascular complications including transplant artery stenosis and arteriovenous fistula, although it is of limited use in the diagnosis of chronic rejection. This article will discuss the role of ultrasound in all its guises and how its efficacy in both the early transplant period in the monitoring of graft dysfunction and in the detection of the more chronic conditions including transplant artery stenosis and arteriovenous fistulae. A more limited role for ultrasound also exists in the long-term follow-up of patients and to aid the detection of complications including susceptibility to malignancy.

Ureteritis and cholecystitis: two unusual manifestations of cytomegalovirus disease in renal transplant recipients

BACKGROUND

Common clinical manifestations of cytomegalovirus (CMV) infection include flu-like symptoms with fever, diarrhea, leukopenia, and elevated liver enzymes. Diagnosis is made by detection of the virus by buffy-coat blood culture or by polymerase chain reaction (PCR) analysis.

METHODS

Here we describe two renal transplant recipients who presented with unusual manifestations of CMV disease (cholecystitis and ureteritis). In both patients, no symptoms or signs of systemic CMV infection were present, and they were thought to have other common causes for cholecystitis and ureteral obstruction.

RESULTS

Retrospective analysis of peripheral blood by PCR analysis was positive for CMV DNA. Histologic examination of the resected gall bladder and stenotic ureteric segment showed CMV inclusions, confirmed subsequently by in situ hybridization. Thus, we report that CMV infection may present with acute cholecystitis or ureteral obstruction without its classical clinical symptoms.

CONCLUSIONS

Because CMV infection is common in transplant patients, the atypical manifestations of CMV should be considered in the differential diagnosis of posttransplant complications. Detection of CMV DNA in the peripheral blood by PCR analysis may help identify these patients.