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Renal Transplant Interventions

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Abstract

Percutaneous interventional diagnostic and therapeutic techniques are commonly employed when post-renal transplantation complications develop. Postoperative complications are less than 10%, but when they do occur, they can have a significant impact on morbidity and mortality. In addition to routine surveillance biopsies, patients with graft dysfunction typically undergo percutaneous biopsy as a diagnostic tool. Advances in interventional radiology techniques to treat vascular and urologic issues have obviated the need for surgical revision. Vascular complications include arterial and venous stenosis, arterial and venous thrombosis, arteriovenous fistula, and pseudoaneurysm. Nonvascular complications consist of urologic issues such as ureteral obstruction, including ureteral strictures and stones, pyeloureteritis cystica, and perigraft fluid collections, including urinoma, hematoma, seroma, abscess, or lymphocele.

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References

  1. Kasiske B, Vazquez M, Harmon W, Brown R, Danovitch G, Gaston R. Recommendations for the outpatient surveillance of renal transplant recipients. J Am Soc Nephrol. 2000;11(Suppl 15):S1–86.

    PubMed  Google Scholar 

  2. Racusen LC, Solez K, Colvin RB, et al. The Banff 97 working classification of renal allograft pathology. Kidney Int. 1999;55(2):713–23.

    Article  CAS  PubMed  Google Scholar 

  3. Patel MD, Phillips CJ, Young SW, et al. US-guided renal transplant biopsy: efficacy of a cortical tangential approach. Radiology. 2010;256:290–6.

    Article  PubMed  Google Scholar 

  4. LaBerge JM. Interventional management of renal transplant arteriovenous fistula. Semin Interv Radiol. 2004;21(4):239–46.

    Article  Google Scholar 

  5. Bach D, Wirth C, Schott G, Hollenbeck M, Grabensee B. Percutaneous renal biopsy: 3 years of experience with the biopsy gun in 761 cases—a survey of results and complications. Int Urol Nephrol. 1999;31:15–22.

    Article  CAS  PubMed  Google Scholar 

  6. Copelan A, George D, Kapoor B, et al. Iatrogenic-related transplant injuries: the role of the interventional radiologist. Semin Intervent Radiol. 2015;32:133–55.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Martinez T, Palomares M, Bravo JA, et al. Biopsy induced arteriovenous fistula and venous aneurysm in a renal transplant. Nephrol Dial Transplant. 1998;13:2937–9.

    Article  CAS  PubMed  Google Scholar 

  8. Ray CE Jr. Renal embolization. Semin Interv Radiol. 2001;18:37–45.

    Article  Google Scholar 

  9. Maleux G, Messiaen T, Stockx L, Vanrenterghem Y, Wilms G. Transcatheter embolization of biopsy-related vascular injuries in renal allografts. Long-term technical, clinical and biochemical results. Acta Radiol. 2003;44(1):13–7.

    CAS  PubMed  Google Scholar 

  10. Srivastava A, Kumar J, Sharma S, et al. Vascular complication in live related renal transplant: an experience of 1945 cases. Indian J Urol. 2013;29:42–7.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Chen W, Kayler LK, Zand MS, et al. Transplant renal artery stenosis: clinical manifestations, diagnosis and therapy. Clin Kidney J. 2015;8:71–8.

    Article  CAS  PubMed  Google Scholar 

  12. Pappas P, Zavos G, Kaza S, et al. Angioplasty and stenting of arterial stenosis affecting renal transplant function. Transplant Proc. 2008;40(5):1391–6.

    Article  CAS  PubMed  Google Scholar 

  13. Kobayashi K, Censullo ML, Rossman LL, et al. Interventional radiologic management of renal transplant dysfunction: indications, limitations, and technical considerations. Radiographics. 2007;27:1109–30.

    Article  PubMed  Google Scholar 

  14. Rajan DK, Stavropoulos SW, Shlansky-Goldberg RD. Management of transplant renal artery stenosis. Semin Intervent Radiol. 2004;21(4):259–69.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Biederman DM, Fischman AM, Titano JJ, et al. Tailoring the endovascular management of transplant renal artery stenosis. Am J Transplant. 2015;15:1039–49.

    Article  CAS  PubMed  Google Scholar 

  16. Estrada CC, Musani M, Darras F, et al. 5 years experience with drug eluting and bare metal stents as primary intervention in transplant renal artery stenosis. Transplantation Direct. 2017;3:e128.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Hanna RF, Hao F, Kraus G, et al. Renal transplant arterial stenosis treated with bare-metal versus drug-eluting stents: comparison of treatment outcomes. Transplant Proc. 2015;47:2881–5.

    Article  CAS  PubMed  Google Scholar 

  18. Merkus JW, Van Asten WN, Hoitsma AJ, et al. Iliac artery stenosis after kidney transplantation. Acta Chir Belg. 1993;93(5):242–8.

    CAS  PubMed  Google Scholar 

  19. Rerolle JP, Antoine C, Raynaud A, et al. Successful endoluminal thrombo-aspiration of renal graft venous thrombosis. Transpl Int. 2000;13:82–6.

    Article  CAS  PubMed  Google Scholar 

  20. Bakir N, Sluiter WJ, Ploeg RJ, van Son WJ, Tegzess AM. Primary renal graft thrombosis. Nephrol Dial Transplant. 1996;11(1):140–7.

    Article  CAS  PubMed  Google Scholar 

  21. Ortega Herrera R, Medina Benítez A, Hernández Abad MJ. Renal vein partial thrombosis in 3 recipients of kidney transplantation. Arch Esp Urol. 2000;53(1):45–8.

    CAS  PubMed  Google Scholar 

  22. Giustacchini P, Pisanti F, Citterio F, De Gaetano AM, Castagneto M, Nanni G. Renal vein thrombosis after renal transplantation: an important cause of graft loss. Transplant Proc. 2002;34(6):2126–7.

    Article  CAS  PubMed  Google Scholar 

  23. Donckier V, De Pauw L, Ferreira J, et al. False aneurysm after transplant nephrectomy: report of two cases. Transplantation. 1995;60:303–4.

    Article  CAS  PubMed  Google Scholar 

  24. Fananapazir G, Hannsun G, Wright LA, Corwin MT, Troppmann C. Diagnosis and management of transplanted kidney extrarenal pseudoaneurysms: a series of four cases and a review of the literature. Cardiovasc Intervent Radiol. 2016;39:1649–53.

    Article  PubMed  Google Scholar 

  25. Low G, Crockett AM, Leung K, et al. Imaging of vascular complications and their consequences following transplantation in the abdomen. Radiographics. 2013;33:633–52.

    Article  PubMed  Google Scholar 

  26. Obed A, Uihlein DC, Zorger N, et al. Severe renal vein stenosis of a kidney transplant with beneficial clinical course after successful percutaneous stenting. Am J Transplant. 2008;8:2173–6.

    Article  CAS  PubMed  Google Scholar 

  27. Jones G, Tibballs J, Al-Akraa M, et al. Iliac vein stenosis as a reversible cause of renal transplant dysfunction. Nephrol Dial Transplant. 2004;19:2415–6.

    Article  PubMed  Google Scholar 

  28. Kim JH, Bae SM, Park S. Ipsilateral leg swelling after renal transplantation as an alarming sign of iliac vein stenosis. Kidney Res Clin Pract. 2014;33:217–21.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Cercueil JP, Chevet D, Mousson C, et al. Acquired vein stenosis of renal allograft—percutaneous treatment with self-expanding metallic stent. Nephrol Dial Transplant. 1997;12:825–6.

    Article  CAS  PubMed  Google Scholar 

  30. Streeter EH, Little DM, Cranston DW, Morris PJ. The urological complications of renal transplantation: a series of 1535 patients. BJU Int. 2002;90(7):627–34.

    Article  CAS  PubMed  Google Scholar 

  31. Shoskes DA, Hanbury D, Cranston D, Morris PJ. Urological complications in 1,000 consecutive renal transplant recipients. J Urol. 1995;153(1):18–21.

    Article  CAS  PubMed  Google Scholar 

  32. Kumar S, Ameli-Renani S, Hakim A, Jeon JH, Shrivastava S, Patel U. Ureteral obstruction following renal transplantation: causes, diagnosis and management. Br J Radiol. 2014;87:20140169.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Kumar S, Jeon JH, Hakim A, Shrivastava S, Banerjee D, Patel U. Long-term graft and patient survival after balloon dilation of ureteric stenosis after renal transplant: a 23-year retrospective matched cohort study. Radiology. 2016;281(1):301–10. https://doi.org/10.1148/radiol.2016151629.

    Article  PubMed  Google Scholar 

  34. Aytekin C, Boyvat F, Harman A, Ozyer U, Colak T, Haberal M. Percutaneous therapy of ureteral obstructions and leak after renal transplantation: long-term results. Cardiovasc Intervent Radiol. 2007;30(6):1178–84.

    Article  PubMed  Google Scholar 

  35. Berli JU, Montgomery JR, Segev DL, et al. Surgical management of early and late ureteral complications after renal transplantation: techniques and outcomes. Clin Transplant. 2015;29(1):26–33.

    Article  PubMed  Google Scholar 

  36. Fontaine AB, Nijjar A, Rangaraj R. Update on the use of percutaneous nephrostomy/balloon dilation for the treatment of renal transplant leak/obstruction. J Vasc Interv Radiol. 1997;8(4):649–53.

    Article  CAS  PubMed  Google Scholar 

  37. Lojanapiwat B, Mital D, Fallon L, et al. Management of ureteral stenosis after renal transplantation. J Am Coll Surg. 1994;179(1):21–4.

    CAS  PubMed  Google Scholar 

  38. Kawashima A, Vrtiska TJ, Leroy AJ, et al. CT urography. Radiographics. 2004;24(Suppl 1):S35–54.

    Article  PubMed  Google Scholar 

  39. Joffre F, Otal P, Soulie M. Radiological imaging of the ureter. Springer; 2003. ISBN: 3540655212.

    Google Scholar 

  40. Petersen RO, Sesterhenn IA, Davis CJ. Urologic pathology. Farrar, Straus, and Giroux; 2009. ISBN: 0781753430.

    Google Scholar 

  41. Beland MD, Gervais DA, Levis DA, Hahn PF, Arellano RS, Mueller PR. Complex abdominal and pelvic abscesses: efficacy of adjunctive tissue-type plasminogen activator for drainage. Radiology. 2008;247(2):567–73.

    Article  PubMed  Google Scholar 

  42. Johnson SP, Berry RS. Interventional radiological management of the complications of renal transplantation. Semin Interv Radiol. 2001;18:47–58.

    Article  Google Scholar 

  43. Akbar SA, Jafri SZ, Amendola MA, Madrazo BL, Salem R, Bis KG. Complications of renal transplantation. RadioGraphics. 2005;25(5):1335–56.

    Article  PubMed  Google Scholar 

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Correspondence to Catherine T. Vu M.D. .

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Vu, C.T., Doskocil, B., Sheen, L. (2018). Renal Transplant Interventions. In: Fananapazir, G., Lamba, R. (eds) Transplantation Imaging. Springer, Cham. https://doi.org/10.1007/978-3-319-75266-2_9

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  • DOI: https://doi.org/10.1007/978-3-319-75266-2_9

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