|ECR 2018 / C-0644|
|What the radiologist needs to know about normal findings and complications of kidney transplant|
Over the years, renal transplantation has become the treatment of choice in end-stage renal disease, with improved patient survival and better quality of life.
The radiologic appearance and potential postoperative complications are related to the surgical procedure. Careful understanding of the different surgical procedures is mandatory to recognize and understand the potential complications.
Generally, the kidney is grafted in patient’s right or left iliac fossa with end-to-side anastomosis to the external iliac vessels.
The arterial anastomosis relies on the type of graft Fig. 1 :
- Cadaveric kidneys are usually harvested with an intact renal artery and an aortic patch which can be cut and linked in an end-to-side way to the recipient external iliac artery.
- Living donor’s kidneys can either be anastomosed by end-to-side to the recipient external iliac artery or by end-to-end to the recipient internal iliac artery.
- Multiple renal arteries can be anastomosed either separately or joined together.
Venous anastomosis is always done in an end-to-side conformation with the recipient external iliac vein.
Ureteroneocystostomy is the most common urinary tract anastomosis, in which the ureter is implanted directly into the recipient bladder, superiorly and posteriorly to the native ureterovesical junction.
Nevertheless, surgical procedures are highly variable. The graft can be placed either intra- or extra-peritonally, in the right or left iliac fossa, with its vascular anastomosis to the internal or external iliac vessels. Finally, the ureter can also be implanted into an interposed bowel segment.