1.4 Renal Transplants Flashcards
Renal transplants are standard treatment for?
Chronic renal failure
What is the term for kidney transplanted from one human to another?
Renal Allograft
Kidney can be harvested from (2)?
- living doner
2. brain dead donor
What is another name for a brain dead donor?
Cadaveric donor
Where are the transplanted kidneys placed?
Iliac Fossa
between the peritoneum and the iliacus muscle
(more superficial)
What happens to the native kidneys?
left in place
In long term Dialysis pateints the native kidneys are prone to?
Cysts and neoplasms
Allograft ureter is passed ___________ thru the muscular layer of the bladder
obliquely
What does the Allograft ureter form?
Non-refluxing UV junction
How is the allograft vein is anastomosed?
End to side with the iliac vein
Allograft artery has One or Many ways of being attached?
Many
Do transplanted kidneys look similar or different to native?
Similar
Post transplant kidneys may appear more___________ due to lack of attenuating structures over them
echogenic
Allograft usually _________ over period of months following transplant
Enlarges (up to 30%)
What could the enlargement of the kidney be mistaken for?
Rejection
Slight dilatation of the collecting system is called ____ and is common in allograft
Hydronephrosis
When should a baseline study be done after operation
Within 72 hours
List the Complications of Renal transplant (7)
- Rejection
- Acute Tubular necrosis
- Av Fistula
- Arterial Stenosis
- Perigraft Fluid
- Pseudoaneurysm
- Venous/Arterial Thrombosis
Should rejection be diagnosed Sonographically?
No
not unless several rejection related abnormalities are present
What will rejection waveforms look like?
High resistance
with minimal to absent diastolic flow
What will the rejection RI be ?
> /= 0.7 is abnormal
Acute Tubular necrosis is a post surgical response resulting from?
Ischemia
Acute Tubular Necrosis does not usually alter Doppler BUT an increase in ______ could be seen
PI (pulsatility index)
What are examples of perigraft fluid (4)
- Seromas
- Hematomas
- Abscessess
- Urinomas
What does color doppler help detect in these collections?
Active bleeding
AV fistula often occurs from?
Biopsy Trauma
AV fistula are commonly symptomatic or asymptomatic?
asymptomatic
AV fistula may be associated with?
Sustained hypertension
AV fistula appears as a __________spot in the renal ______ due to its ________ flow.
Bright; parenchyma; disturbed
High velocity flow in the ______ artery with a visible Color Doppler_____
Feeder artery; bruit
How common are venous/arterial thrombosis in transplants (%)?
< 1%
How soon do venous/arterial thrombosis happen if they do?
immediately post operation
What do venous/arterial thrombosis look like on 2D (3)?
- enlarged kidney
- distended renal vein
- absent flow signals in renal vein/artery
What is the most common vascular complication occurring in transplanted patients?
Arterial stenosis
What percentage of Arterial stenosis occurs in transplanted patients?
10 %
Where does the Arterial stenosis usually occur ?
at the anastomosis
What is the Arterial stenosis usually due to?
Surgical issues
Do older or newer transplants have long segment stenosis?
Older
What is the long segment stenosis due to? (2)
- Scarring
or - Hyperplasia
Doppler shows ______ velocity in the stenotic segment post stenotic turbulence and distal _____ with severe stenosis
Increased; dampening
