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Franke D. The diagnostic value of Doppler ultrasonography after pediatric kidney transplantation. Pediatr Nephrol 2022; 37:1511-1522. [PMID: 34477970 PMCID: PMC9192382 DOI: 10.1007/s00467-021-05253-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Revised: 07/13/2021] [Accepted: 07/19/2021] [Indexed: 12/27/2022]
Abstract
Ultrasonography (US) plays a major diagnostic role in the pre- and post-transplant evaluation of recipient and donor. In most cases, US remains the only necessary imaging modality. After pediatric kidney transplantation, US can ensure immediate bedside diagnosis of vessel patency and possible postoperative non-vascular complications. Criteria for US diagnosis of kidney vessel thrombosis and stenosis in the transplant will be presented. Non-vascular complications after kidney transplantation include hydronephrosis, hematoma, lymphocele, and abscess. US can detect suggestive, but nevertheless non-specific, acute signs (sudden increase in volume and elevated resistive index), and chronic rejection, which therefore remains a histological diagnosis. US is of little or no help in detection of tubular necrosis or drug toxicity, but it can exclude other differential diagnoses. This educational review provides a practical and systematic approach to a multimodal US investigation of the kidney transplant. It includes a short overview on possible indications for contrast-enhanced ultrasonography (CEUS) in children after kidney transplantation.
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Affiliation(s)
- Doris Franke
- Pediatric Ultrasonography, Clinic for Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Carl-Neuberg-Str 1, 30625, Hannover, Germany.
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Shampain KL, Liles AL, Chong ST. Imaging of Transplant Emergencies. Semin Roentgenol 2020; 55:115-131. [PMID: 32438975 DOI: 10.1053/j.ro.2019.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Amber L Liles
- Department of Radiology, Michigan Medicine, Ann Arbor, MI
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Taffel MT, Nikolaidis P, Beland MD, Blaufox MD, Dogra VS, Goldfarb S, Gore JL, Harvin HJ, Heilbrun ME, Heller MT, Khatri G, Preminger GM, Purysko AS, Smith AD, Wang ZJ, Weinfeld RM, Wong-You-Cheong JJ, Remer EM, Lockhart ME. ACR Appropriateness Criteria ® Renal Transplant Dysfunction. J Am Coll Radiol 2018; 14:S272-S281. [PMID: 28473084 DOI: 10.1016/j.jacr.2017.02.034] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 02/20/2017] [Accepted: 02/21/2017] [Indexed: 02/06/2023]
Abstract
Renal transplantation is the treatment of choice in patients with end-stage renal disease because the 5-year survival rates range from 72% to 99%. Although graft survival has improved secondary to the introduction of newer immunosuppression drugs and the advancements in surgical technique, various complications still occur. Ultrasound is the first-line imaging modality for the evaluation of renal transplants in the immediate postoperative period and for long-term follow-up. In addition to depicting many of the potential complications of renal transplantation, ultrasound can also guide therapeutic interventions. Nuclear medicine studies, CT, and MRI are often helpful as complementary examinations for specific indications. Angiography remains the reference standard for vascular complications and is utilized to guide nonsurgical intervention. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer-reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | - Myles T Taffel
- Principal Author, George Washington University Hospital, Washington, District of Columbia.
| | - Paul Nikolaidis
- Panel Vice-chair, Northwestern University, Chicago, Illinois
| | | | - M Donald Blaufox
- Albert Einstein College of Medicine, Bronx, New York; Society of Nuclear Medicine and Molecular Imaging
| | - Vikram S Dogra
- University of Rochester Medical Center, Rochester, New York
| | - Stanley Goldfarb
- University of Pennsylvania School of Medicine, Philadelphia; Pennsylvania, American Society of Nephrology
| | - John L Gore
- University of Washington, Seattle, Washington; American Urological Association
| | | | | | | | | | - Glenn M Preminger
- Duke University Medical Center, Durham, North Carolina; American Urological Association
| | | | - Andrew D Smith
- The University of Mississippi Medical Center, Jackson, Mississippi
| | - Zhen J Wang
- University of California San Francisco School of Medicine, San Francisco, California
| | - Robert M Weinfeld
- Oakland University William Beaumont School of Medicine, Troy, Michigan
| | | | | | - Mark E Lockhart
- Panel Chair, University of Alabama at Birmingham, Birmingham, Alabama
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New Dimensions in Renal Transplant Sonography: Applications of 3-Dimensional Ultrasound. Transplantation 2017; 101:1344-1352. [PMID: 28291767 DOI: 10.1097/tp.0000000000001206] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND The aim of this study is to demonstrate the usefulness of adding 3-dimensional (3D) ultrasound in evaluation of renal transplant vasculature compared to 2-dimensional (2D) Duplex ultrasound. METHODS One hundred thirteen consecutive renal transplant 2D and 3D ultrasound examinations were performed and retrospectively reviewed by 2 board-certified radiologists and a radiology resident individually; each reviewed 2D and then 3D images, including color and spectral Doppler. They recorded ability to visualize the surgical anastomosis and rated visualization on a subjective scale. Interobserver agreement was evaluated. Variant anastomosis anatomy was recorded. Tortuosity or stenosis was evaluated if localized Doppler velocity elevation was present. RESULTS The reviewers directly visualized the anastomosis more often with 3D ultrasound ((Equation is included in full-text article.)=97.5%) compared with 2D ((Equation is included in full-text article.)=54.5%) [difference in means (DM) = 43% (95% confidence interval (CI) = 36%-50%) (P < 0.001)]. The reviewers visualized the anastomosis more clearly with 3D ultrasound (P < 0.001) [difference in medians = 0.5, 1.0, and 1.0, (95% CI = 0.5-1.0, 0.5-1.0, and 1.0-1.5)]. Detection of variant anatomy improved with 3D ultrasound by 2 reviewers [DM = 7.1% and 8.9% (95% CI = 1%-13% and 4%-14%, respectively) (P < 0.05)]. There was high interobserver agreement [(Equation is included in full-text article.)= 95.3%, (95% CI = 91.9%-98.7%) regarding anastomosis visualization among reviewers with wide-ranging experience. CONCLUSIONS Direct visualization of the entire anastomosis was improved with 3D ultrasound. Three-dimensional evaluation improved detection of anatomic variants and identified tortuosity as the likely cause of borderline localized elevation in Doppler velocity. The data added by 3D ultrasound may obviate confirmatory testing with magnetic resonance angiography or computed tomographic angiography after equivocal 2D ultrasound results.
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Granata A, Clementi S, Londrino F, Romano G, Veroux M, Fiorini F, Fatuzzo P. Renal transplant vascular complications: the role of Doppler ultrasound. J Ultrasound 2014; 18:101-7. [PMID: 26191097 DOI: 10.1007/s40477-014-0085-6] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Accepted: 03/14/2014] [Indexed: 12/15/2022] Open
Abstract
Improvements in the care of kidney transplant recipients and advances in immunosuppressive therapy have reduced the incidence of graft rejection. As a result, other types of kidney transplant complications, such as surgical, urologic, parenchymal, and vascular complications, have become more common. Although vascular complications account for only 5-10 % of all post-transplant complications, they are a frequent cause of graft loss. Ultrasonography, both in B-mode and with Doppler ultrasound, is a fundamental tool in the differential diagnosis of renal allograft dysfunction. Doppler ultrasound is highly specific in cases of transplanted renal artery stenosis, pseudoaneurysms, arteriovenous fistulas, and thrombosis with complete or partial artery or vein occlusion. A single measurements of color Doppler indexes display high diagnostic accuracy and in particular cases are more useful during the post-transplantation follow-up period. More recent techniques, such as contrast-enhanced ultrasound, undoubtedly increase the accuracy of ultrasonography in the diagnosis of vascular complications involving the transplanted kidney.
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Affiliation(s)
- Antonio Granata
- Nephrology and Dialysis Unit, "St. Giovanni di Dio" Hospital, Agrigento, Italy ; Via F. Paradiso n°78/a, 95024 Acireale (CT), Italy
| | - Silvia Clementi
- Medical Oncology Unit, Humanitas, Centro Catanese di Oncologia, Catania, Italy
| | | | - Giulia Romano
- Internal Medicine Unit, AOU "Vittorio Emanuele, Policlinico", Catania, Italy
| | - Massimiliano Veroux
- Vascular Surgery and Organ Transplant Unit, University Hospital of Catania, Catania, Italy
| | - Fulvio Fiorini
- Nephrology and Dialysis Unit, "Santa Maria della Consolazione" Hospital, Rovigo, Italy
| | - Pasquale Fatuzzo
- Cattedra di Nefrologia, Scuola di Specializzazione in Nefrologia, University Hospital of Catania, Catania, Italy
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