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Transplants Flashcards

1
Q

Where is the common locations for renal transplants?

A

Rt iliac fossa, artery right internal iliac, and vein to right external iliac

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2
Q

When is U/S performed post surgery?

A

First 24 hours and whenever complications arise

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3
Q

What renal components are examined in grayscale?

A

Renal collecting system (hydronephrosis), perinephric space for fluid collections

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4
Q

Which renal vessels are examined with Doppler?

A

Main renal artery/vein (anastomoses), adjacent external iliac artery/vein, and intrarenal arteries

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5
Q

Which areas of main renal arteries should be measured with Doppler?

A

Velocity measurements (anastomosis and distal area) color aliasing for high flow

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6
Q

How high can normal PSV be in a renal transplant artery?

A

250 cm/sec

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7
Q

What is the formula to determine RI?

A

PSV - EDV / PSV ( N

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8
Q

What is the formula to determine Pulsatility index (PI) ?

A

PSV - EDV / EDV ( N

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9
Q

What is the normal RAR?

A
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10
Q

What is the normal Acceleration Time (AT) ?

A
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11
Q

How is the aorta below Celiac Axis involved in calculations?

A

PSV of renal / PSV of aorta below Celiac Axis

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12
Q

How are Color and Spectral Doppler images obtained with the external iliac artery/vein?

A

Cephalad to main renal artery/vein anastomoses, renal artery to iliac artery PSV ratio

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13
Q

How are Color and Spectral Doppler images obtained with the intrarenal arteries?

A

Entire kidney, Doppler indices from interlobar segmental arteries (upper pole, interpolar, lower pole) for AT if there’s tardus parvus

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14
Q

How are Color and Spectral Doppler images obtained with the intrarenal veins?

A

Color and Doppler waveforms for assessing venous flow within transplant

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15
Q

What is the rate of acute and chronic renal rejection?

A

40% acute usually in first month, 60% chronic usually after first year

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16
Q

What are measurements indicating renal rejection?

A

RI > 0.9, PI 1.8 and chronic graft will be hyperechoic / low perfusion

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17
Q

What are findings with renal vein thrombosis?

A

Sudden anuria, pain/swelling of graft, no flow on vein with reverse diastolic flow within intrarenal arterial system

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18
Q

How is grayscale evaluation of liver transplant done?

A

Long/tran views, parenchyma (focal/diffuse abnormalities), echogenicity and texture

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19
Q

What should be checked with the biliary tree when evaluating liver transplant?

A

Caliber of the common duct measured

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20
Q

What should be checked with the subphrenic and subhepatic spaces in liver transplant?

A

Possible fluid collections

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21
Q

Which hepatic vessels should grayscale exam include with liver transplant?

A

Portal vein, hepatic veins, and IVC

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22
Q

Which vessels should be examined with Doppler in liver transplant?

A

Main hepatic artery, R/L intrahepatic arteries, hepatic veins, IVC, main portal vein, and intrahepatic portal veins

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23
Q

Which vascular anastomoses should be examined with Doppler in liver transplant?

A

Hepatic arterial, portal venous, hepatic venous and IVC

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24
Q

Why should main/intrahepatic arteries be examined with liver transplant?

A

Confirm normal flow, check for thrombosis, stenosis, a pseudo aneurysm or arteriovenous fistula

25
What is the resistance index (RI) of the hepatic artery?
0.5 to 0.7
26
What is the acceleration time (AT) of PSV in hepatic artery?
27
What is common in the immediate postoperative period in liver transplant?
Decreased diastolic flow and high resistive indices attributed to edema/vasospasm
28
Where are high resistive indices detected in liver transplant?
Main hepatic artery, parenchymal branches (72 hours post-op / resolves in 2 weeks)
29
What types of surgical anastomoses exist with Hepatic Veins and IVC?
Piggyback and interposition
30
What is the most common postoperative arterial complication in liver?
Hepatic Artery Thrombosis
31
What is the most common postoperative arterial complication in liver?
Hepatic Artery Thrombosis (First 3 months with mortality rate of 60%)
32
What are findings of Hepatic Artery Thrombosis?
Lack of arterial flow within the porta hepatis or liver parenchyma, increased RI
33
Where is the most common site of significant hepatic artery stenosis?
Donor-recipient anastomotic site
34
What is PSV of H.A.S.?
PSV > 2 m/s (or twice as much as prestenotic)
35
What is tardus parvus poststenotic in H.A.S.?
AT > 80 m/s, RI
36
Where does portal vein stenosis occur?
Anastomotic site
37
How much luminal narrowing occurs in Portal Vein Stenosis?
38
What are PSV measurements in portal vein stenosis?
> 150 cm/s at the anastomosis, or 3/4 - fold PSV increase compared to prestenotic
39
Where does portal vein thrombosis occur?
At the site of anastomosis
40
How does portal vein thrombosis appear?
Echogenic or isoechoic (acute) intraluminal filling with absent/partial flow
41
How is renal to aortic ratio calculated?
PSV of renal / PSV of aorta below Celiac Axis
42
How does portal vein thrombosis appear?
Echogenic or isoechoic (acute) intraluminal filling with absent/partial flow with HA RI
43
What is the common sonographic finding in a patient who is in renal failure immediately following a transplant?
Perirenal fluid collection
44
Fluid collections commonly associated with renal transplants include ....?
Hematoma, abscess, lymphocele, urinoma
45
Fluid collections commonly associated with liver transplants include.....?
Hematoma, abscess, seroma, biloma, ascites
46
Which of the following liver transplantation methods are related to the highest rate of recipient complication?
Split liver / cadaver donor
47
Early acute liver allograft rejection is often demonstrated by.....?
Portal vein thrombosis
48
Post-transplant examination of a liver transplant should include images of how many anastomotic areas for patency and evidence of stenosis?
Five
49
What is the ureter of the transplanted kidney anastomosed to?
Dome of bladder
50
What immunosuppressants prevent transplant rejection without infectious complications or drug toxicity?
Cyclosporine A, Tacrolimus, Steroids, azathiprine, mycophenolate, antibody therapy (2 agents/anti-interleukin), humoral agents (OKT3/antithymocyte globulin
51
What are abnormal Doppler waveforms with a renal baseline study?
Loss of diastolic flow, increased RI, high velocity flow jets and reversal of flow
52
What complications do you monitor in a renal baseline study?
Fluid collection, post-transplant lymphoproliferative disorder, anastomotic leaks/vascular strictures
53
What is Acute Tubular Necrosis (ATN) more common in?
Cadaver transplants
54
What is the problem occurring in ATN?
Delayed function / mild increase in length of allograft
55
What do 10% - 30% of patients require the first 2 weeks of ATN?
Dialysis
56
What affects up to 40% of patients in the first 3 weeks following renal transplantation?
Acute rejection (biopsy required)
57
What occurs with the graft in renal acute rejection?
Increase in length and width
58
How does Spectral Doppler appear with renal acute rejection?
Absence of diastolic flow/flow reversal, PI 1.8 (pathology), RI > 0.7 (pathology)
59
How does chronic renal rejection appear?
Increased parenchymal echogenicity, reduction in the intrarenal vessels

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