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Interventional Radiologic Management of Renal Transplant Dysfunction: Indications, Limitations, and Technical Considerations¹

¹ From the Department of Diagnostic and Interventional Imaging (K.K., M.L.C., L.L.R., P.N.K., A.M.C.), and the Division of Immunology and Organ Transplantation, Department of Surgery (B.D.K.), University of Texas Medical School at Houston, 6431 Fannin St, Houston, TX 77030. Presented as an education exhibit at the 2005 RSNA Annual Meeting. Received July 13, 2006; revision requested September 1 and received October 17; accepted October 19. All authors have no financial relationships to disclose. Address correspondence to K.K. (e-mail: Katsuhiro.Kobayashi{at}di.mdacc.tmc.edu).

Renal transplantation is the treatment of choice for most patients with end-stage renal disease. However, in spite of continuous progress in surgical techniques and immunosuppressive therapy, a wide variety of vascular and nonvascular complications can arise postoperatively. Vascular complications include transplant renal artery stenosis, arteriovenous fistulas or intrarenal pseudoaneurysms following renal transplant biopsy, extrarenal pseudoaneurysms, and graft thrombosis. Nonvascular complications include urologic complications (eg, ureteral obstruction, urine leak) and perigraft fluid collections (eg, lymphocele, abscess, hematoma, urinoma). These postoperative complications can be diagnosed and managed with minimally invasive techniques; however, an understanding of renal transplant anatomy and the risks of posttransplantation immunosuppressive therapy unique to this patient population is essential to their successful application. In addition, familiarity with the indications for and limitations of these techniques as well as collaboration between the radiologist and the transplantation surgeon are vital for maximizing the chances of renal allograft survival.

© RSNA, 2007