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Review
. 2014 Apr 11;18(2):101-7.
doi: 10.1007/s40477-014-0085-6. eCollection 2015 Jun.

Renal transplant vascular complications: the role of Doppler ultrasound

Antonio Granata  1 , Silvia Clementi  2 , Francesco Londrino  3 , Giulia Romano  4 , Massimiliano Veroux  5 , Fulvio Fiorini  6 , Pasquale Fatuzzo  7
Affiliations
Review

Renal transplant vascular complications: the role of Doppler ultrasound

Antonio Granata et al. J Ultrasound. .

Abstract
in English, Italian

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.

La progressiva riduzione dell’incidenza del rigetto ha reso più frequenti le complicanze urologiche, chirurgiche, parenchimali e vascolari. Queste ultime, pur rappresentando soltanto il 5–10 % di tutte le complicanze post-trapianto, sono frequente causa di perdita del graft. L’esame ultrasonografico, sia in B-mode che con l’ausilio del color Doppler, è fondamentale nella diagnosi differenziale delle cause che possono innescare una disfunzione del graft. Sebbene sia ormai indiscussa la sua utilità nella diagnosi di complicanze parenchimali, chirurgiche e urologiche, non è ancora consolidato il suo ruolo in caso di complicanze a carico dell’asse vascolare renale. L’ecocolor-Doppler, in particolare, possiede una specificità tale da poter essere considerato uno strumento diagnostico nella maggior parte delle complicanze vascolari del rene trapiantato, sia acute (occlusione parziale o totale dei vasi renali) che croniche (stenosi dell’arteria renale, pseudo aneurisma e fistola artero-venosa) Gli indici color-Doppler possiedono, infatti, una alta accuratezza diagnostica nella loro singola determinazione, risultando in casi particolari più utili nel follow-up. L’utilizzo di tecniche più moderne, come il mezzo di contrasto ecografico, consente indubbiamente di aumentare l’accuratezza diagnostica dell’esame ultrasonografico nel caso delle complicanze vascolari del rene trapiantato.

Keywords: Doppler ultrasound; Renal transplant; Ultrasonography; Vascular complications.

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Figures

Fig. 1
Fig. 1
Renal artery stenosis. a Color Doppler study shows mosaic pattern at the site of the anastomosis and a significant increase in the peak systolic velocity (460 cm/s). b Spectral analysis shows a “tardus-parvus” waveform at the level of the arcuate artery
Fig. 2
Fig. 2
Thrombosis of the transplanted renal vein. a Color Doppler ultrasound shows “reverse” diastolic flow (below the baseline); b color imaging of the hilar region shows two segmental arteries (A) and no flow in the renal vein (V)
Fig. 3
Fig. 3
Stenosis of the transplanted renal vein. a Color Doppler ultrasound shows external compression of the homolateral external iliac vein and b a significantly increased PSV (200 cm/s)
Fig. 4
Fig. 4
Color Doppler ultrasound shows large-caliber interlobar artery and vein. The resistance index of the nutrient artery is 0.50 (vs. approximately 0.80 in other regions of the graft). The venous spectrum reflects markedly pulsatile flow that cannot be found in other interlobar veins. Post-biopsy arteriovenous fistula (arrow); a Doppler shows alternating flow
See this image and copyright information in PMC

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