Complications of renal transplantation and the role of interventional radiology

Abstract

As rejection therapy has improved, the interventional complications of renal transplantation have increased in relative importance as potentially reversible causes of graft malfunction and failure. Ultrasonically guided aspiration and drainage techniques are essential for the characterization and subsequent management of perinephric fluid collections that occur in as many as 51% of cases, of which up to 18% may be clinically significant. In a series of 507 consecutive renal transplants, urological complications were seen in 9% of patients, consisting of ureteric obstruction in 6% and urinary leaks in 3%. Detection via ultrasound scanning, evaluation via antegrade pyelography and pressure-flow tests, and management via percutaneous nephrostomy and ureteric stenting all contribute to rapid diagnosis and subsequent treatment. Serial ultrasound scanning of renal transplants and the aggressive use of interventional radiological techniques are vital to the early detection and management of complications, and can lead to preservation of graft function and continued improvement in graft survival figures.