Renal Transplants

Question 1

What is the standard treatment of chronic renal failure?

Answer 1

Renal allograft

Question 2

What is an allograft?

Answer 2

An organ harvested from a living, related donor or a cadaveric donor

Question 3

Where is the transplant kidney placed?

Answer 3

Iliac fossa

Question 4

What are native kidneys prone to?

Answer 4

Cysts and neoplasms

Question 5

Where is the allograft ureter located?

Answer 5

More superior in the bladder

Question 6

What does the allograft ureter form?

Answer 6

Non-refluxing UV junction

Question 7

How is the allograft vein attached to the iliac vein?

Answer 7

End to side

Question 8

What vein is the allograft vein attached to?

Answer 8

Iliac vein

Question 9

How is the allograft artery attached?

Answer 9

Various

Question 10

What sonographic appearance does the allograft have compared to the native kidney/

Answer 10

More echogenic cortex, larger (up to 30% enlarged) over months following transplant, pelvic fullness

Question 11

When should a baseline study of the allograft be done?

Answer 11

72 hrs post op

Question 12

What are some complications of renal transplants?

Answer 12

Rejection, acute tubular necrosis, perigraft fluid, pseuodaneurysm, AV fistula, venous/arterial thrombosis, arterial stenosis

Question 13

What is the waveform like of a rejecting kidney?

Answer 13

High resistance

Question 14

What is the RI like of a rejecting kidney?

Answer 14

> /= 0.7

Question 15

What may mimic rejection?

Answer 15

Cyclosporine toxicity

Question 16

What is acute tubular necrosis?

Answer 16

Post surgical response from ischemia

Question 17

What does the Doppler look like in ATN?

Answer 17

Usually not altered, possible increase in PI

Question 18

What are some examples of perigraft fluid?

Answer 18

Serous, hematoma, abscess, or urinoma

Question 19

Where is perigraft fluid seen?

Answer 19

Post op

Question 20

What can CDI help determine with perigraft fluid?

Answer 20

If there’s active bleeding

Question 21

Where do most pseudoaneurysms occur?

Answer 21

Renal parenchyma (others can occur at arterial anastomosis site)

Question 22

Why do pseudoaneurysms occur?

Answer 22

Arterial laceration from biopsy

Question 23

What is the arterial anastomosis site?

Answer 23

Main artery is connected to allograft artery

Question 24

What does an AV fistula occur from?

Answer 24

Biopsy

Question 25

What are the symptoms of an AV fistula?

Answer 25

Asymptomatic, possible sustained HTN

Question 26

What is the sonographic appearance of an AV fistula?

Answer 26

Bright spot in renal parenchyma due to disturbed blood flow (CDI), increased PSV in feeder artery, bruit

Question 27

How often does venous/arterial thrombosis occur?

Answer 27

<1% of transplants

Question 28

When does venous/arterial thrombosis occur?

Answer 28

Immediately post op

Question 29

What are the sonographic appearance of venous/arterial thrombosis?

Answer 29

Enlarged kidney, distended renal vein, absent flow signals in vein/artery

Question 30

What is the most common vascular complication in renal transplants?

Answer 30

Arterial stenosis

Question 31

When does an acute arterial stenosis occur?

Answer 31

After post op

Question 32

Where does an acute arterial stenosis occur?

Answer 32

Anastomosis (due to surgical issue)

Question 33

What does a chronic arterial stenosis look like?

Answer 33

Long stenosed segment (increased velocity in stenosis, post stenotic turbulence, distal dampening)

Question 34

What is a chronic arterial stenosis due to?

Answer 34

Scarring or hyperplasia