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ECR 2018 / C-0522
Emergency call after renal trasplantation: don’t press the panic button
Congress: ECR 2018
Poster No.: C-0522
Type: Educational Exhibit
Keywords: Kidney, Abdomen, CT, Ultrasound, Ultrasound-Colour Doppler, Complications, Diagnostic procedure, Transplantation
Authors: C. OTERINO SERRANO, S. Moron Hodge, S. Afonso Ramos, S. de Águeda Martín , M. Álvarez Maestro, C. Martín-Hervás; MADRID/ES
DOI:10.1594/ecr2018/C-0522

Background

As the world population ages and end-stage renal disease raises the amount of patients treated by renal replacement therapies continues increasing. Radiologist must be familiarized with this practice.

 

IMAGING TECHNIQUES

Most popular imaging techniques are ultrasounds (US) and helical computed tomography (CT).

 

US can be used in the post-operative period, to detect vascular complications and for long-term follow-up. Also to guide diagnostic and therapeutic interventions.

 

CT is helpful in cases in which US yield non-diagnostic findings. CT depicts anatomy in great detail and CT angiography is effective for vascular complications.

 

Magnetic resonance imaging (MRI) and nuclear medicine (NM) examinations, are usually less available and cost-effective, therefore they remain in a second stage.

 

SURGICAL TECHNIQUES

The transplanted kidney is usually placed extraperitoneally. Usually the right iliac fossa is preferred. Vascular anastomoses are created within the external iliac vasculature.

 

Type of arterial anastomosis depends on type of graft available:

  • Cadaveric kidneys: The graft is collected with the main renal artery attached to a portion of aorta, allowing an end-to-side anastomosis to the recipient external iliac artery.
  • Living-donor kidneys: The transplant main renal artery may be anastomosed to either the external iliac artery by an end-to-side anastomosis or the internal iliac artery by an end-to-end anastomosis.

The donor renal vein is always sutured in an end-to-side anastomosis to the recipient external iliac vein.

 

For restoring urinary drainage, the donor ureter is typically anastomosed to the dome of the recipient urinary bladde. 

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