Ultrasound Doppler Findings In Hyperacute Vascular Rejection And Early Vascular complications In Renal Grafts.

Dr Muktachand L Rokade; Dr Amit Nagrik; Dr Ajay Kanbur; Dr Supriya Dutta; Dr Ulhas Chakraborty; Dr Nikhil Kamat

Volume : VII, Issue : II, February - 2018

Ultrasound Doppler Findings In Hyperacute Vascular Rejection And Early Vascular complications In Renal Grafts.

Dr Muktachand L Rokade, Dr Amit Nagrik, Dr Ajay Kanbur, Dr Supriya Dutta, Dr Ulhas Chakraborty, Dr Nikhil Kamat

Abstract :

Hyperacute vascular rejection is a rare serious event leading to graft loss.Not many reports describing its imaging findings are available in the literature due to its rapidity of onset.

This review decribes the Doppler imaging findings in hyperacute vascular rejection characterized by absent intrarenal arterial flow and graft edema.These finding were further corroborated with contrast enhanced ultrasound and CT angiography that demonstrated nil cortical perfusion.The condition necessitates immediate graft nephrectomy to prevent further sensitization and complications.

Other vascular causes of graft dysfunction include Acute tubular necrosis commonly associated with cadaveric donors(34%) and prolonged warm ischemia time.Increased intrarenal vascular resistive indices and reduced diastolic flow are the observed findings. Similar reduction in the diastolic flow and elevation of the intrarenal resistive indices are also noted in abdominal compartment syndrome a rare cause of acute graft dysfunction .These findings rapidly revert after surgical decompression.

Renal vein thrombosis characterized by early rapid diastolic flow reversal in the renal arterial Doppler.It has reported prevalence of 0.1–4.2% and leads to graft loss.Early identification and institution of thrombolysis/thrombectomy may help in graft survival.Segmental infarction is being increasingly recognized as a cause of graft dysfunction.

Conclusion:Ultrasound Doppler is an important first line modality for the evaluation of the renal transplants.It can accurately predict and characterize important causes of graft dysfunction,helping in early institution of therapy and prolonging graft survival.