SICUS accurately identified small bowel complications and correlated well with MRE and intraoperative findings. SICUS offers an alternative in the preoperative assessment of CD.

Renal transplantation, first performed successfully in the 1950s, is the treatment of choice for most patients with end-stage renal failure. It confers longer term survival and a better quality of life than do both haemodialysis and peritoneal dialysis. The success of renal transplantation is dependent on the preservation of renal graft function and despite the many advances in surgical techniques, immunosuppressive regimens and supportive therapies, many challenges remain including post-operative ureteral obstruction. This complication can pose a risk to graft, and, occasionally, to patient survival. In this pictorial review, we describe the causes of ureteral obstruction following renal transplantation and illustrate the pivotal role of radiology in both diagnosing and managing these complications.

Aim To compare the diagnostic yield of small intestinal contrast ultrasonography (SICUS) with magnetic resonance enterography (MRE) in routine clinical practice in a cohort of pediatric patients investigated for Crohn's disease (CD) attending a UK tertiary center. Methods and Results Patients with suspected or established CD who underwent SICUS were identified retrospectively. SICUS was compared to conventional transabdominal ultrasound (TUS), ileocolonoscopy (IC), and MRE. The accuracy and agreement of SICUS in detecting small bowel lesions and CD‐related complications were assessed using kappa (κ) coefficient statistics. A total of 93 patients (median age 15 years, range 2–17, 49 male) underwent SICUS; 58 had suspected and 35 had established CD. In suspected CD, sensitivity and specificity of SICUS in detecting CD small bowel lesions were 81.8 and 100% and for TUS 85.7 and 87.5%, respectively. In established CD, sensitivity and specificity of SICUS were 98.7 and 100% and TUS 80 and 100%, respectively. Agreement between SICUS and IC was substantial for the presence of lesions (κ = 0.73) but fair in TUS (κ = 0.31). Agreement between SICUS and IC was almost perfect for detecting strictures (κ = 0.84), with a sensitivity of 100% and specificity of 97.6%. When comparing SICUS and TUS with MRE, agreement for the presence of lesions was substantial (κ = 0.63) and moderate (κ = 0.53), respectively. Agreement between SICUS and MRE was substantial for detecting strictures (κ = 0.77) and dilatation (κ = 0.68). Conclusions SICUS offers a radiation‐free alternative for assessing pediatric small bowel CD, with diagnostic accuracy that is comparable to MRE and IC, supporting its wider use in routine practice.

Purpose To study long-term graft and patient survival after percutaneous ureteroplasty of ureteric stenosis after renal transplantation and to compare the outcomes to those of patients who did not develop ureteric stenosis. Materials and Methods An ethical waiver was obtained for this 23-year retrospective matched cohort study of 52 of 1476 consecutive kidney transplant recipients who developed postoperative ureteric stenosis. Data were collected between January 1990 and December 2012. All patients (mean age, 47 years [range, 23-72 years]; 36 men aged 29-72 years [mean age, 49 years] and 24 women aged 23-68 years [mean age, 42 years]) underwent percutaneous ureteroplasty; recurrent stenosis was managed surgically or by means of long-term ureteric stent placement. Outcomes were compared with those of a matched control group of transplant recipients with no history of ureteric stenosis. Primary outcome measures were death-censored graft failure and all-cause mortality. Secondary outcome measures were the effect of time of stricture onset on graft survival, complications, and risk factors for recurrent stenosis. Kaplan-Meier curves were compared by using log-rank tests, with P < .05 indicative of a statistically significant difference. Results Balloon dilation was technically successful in all 52 strictures, but stenosis recurred in 10 patients and was treated with surgery (n = 5) or long-term stent placement (n = 5). The 10-year graft and patient survival were not significantly different in study versus control groups, with graft survival of 64.5% (95% confidence interval [CI]: 43.4%, 79.4%) versus 76.3% (95% CI: 58.6%, 87.2%), respectively (P = .372), and patient survival of 82.2% (95% CI: 62.9%, 92%) versus 89.9% (95% CI: 74.6%, 96.2%) (P = .632). Subgroup analysis showed that stenosis occurring less than 3 months (10-year graft survival, 59.1%), at least 3 months (10-year graft survival, 67.3%), and at least 6 months (10-year graft survival, 53.0%) after transplantation did not adversely affect graft survival compared with that of the control group (P > .05). Cold ischemia time was longer in those with recurrent stenosis than in control subjects (16.1 vs 8.4 hours, respectively; P = .034). The minor and major complication rates were 13% and 5.7%, respectively, with no 30-day graft loss and patient mortality. Conclusion Long-term graft and patient survival in patients with percutaneous ureteroplasty of transplant ureteric stenosis were not significantly worse than those in a control group. (©) RSNA, 2016.

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