To determine the relationship between resistive index (RI) measured by Doppler ultrasound, serum creatinine (SCr), and histopathological changes on biopsy during kidney trans- plant dysfunction in early postoperative period, we studied 47 kidney transplant patients; 61% of the patients had acute transplant rejection, 19% had acute tubular necrosis, 4% had calcineurin inhibitor toxicity, 11% had normal morphology in biopsy, and 5% had changes compatible with pyelonephritis. None of the study patients had interstitial fibrosis or tubular atrophy on biopsy. We found that the sensitivity and specificity of RI in diagnosing transplant dysfunction was highly variable depending on the selected cutoff value. Sensitivity of RI decreased and its specificity increased with increasing the RI thresholds. Using an RI threshold of 0.7 resulted in a high sensitivity of 78% at a cost of very low specificity 40%, whereas using an RI threshold of 0.9 resulted in 100% specificity at a cost of very low sensitivity 16%. Acceptable specificity was only achieved at the expense of very low sensitivity, resulting in poor utility of RI as a screening tool for dysfunction. We found that there were no significant differences in the mean RI value between patients with and without biopsy-proven transplant dysfunction. However, we found a significant correlation between SCr value and RI of 0.383, P = 0.007.
Fungal infection represents 5% of the infections of post renal transplant recipients. The frequency of invasive Aspergillus ranges from 0.5% to 2.2% with a mortality rate of 88%. In renal transplantation, Aspergillus infection usually affects primarily the lungs with occasional dissemination and the central nervous system. Involvement of a renal allograft in the isolated form is rare. A-35-year-old male post-renal transplant patient presented in our institute for routine follow up examination. Ultrasound and computed tomography (CT) were conducted in our radiology department, suggestive of abscess formation in mid pole of transplanted kidney. The patient did not have any clinical symptoms. His serum creatinine level was also within normal limit. Diagnosis of Aspergillus fumigates was made by aspiration of pus. Treatment started according to culture and sensitivity report. Ultimately graft nephrectomy was performed to control infection. Aspergillus infection of a renal allograft remains a key issue for nephrologists and infection specialists. For diagnosis of fungal infection, a high index of suspicious is necessary. In the present case, the infected allograft nephrectomy and the elimination of immune-compromised state and the prompt administration of antifungal therapy, made recovery possible. However, early diagnosis remains difficult.
Background: The portal vein variations are usually asymptomatic and mostly identified incidentally during surgeries and diagnostic angiographies. They are easy to recognize with 3D reconstruction of Computed Tomography. It has significant impact on living-donor liver transplantation. Aim: To determine the spectrum and incidence of the anatomic variations in Intra Hepatic Main and Right Portal vein anatomy detected on Multi-detector CT Hepatic angiography of living liver donor of western Indian population and to discuss its surgical and radiological implications. Material and Method: A retrospective review of multi-detector CT hepatic angiography was performed in patients sent for liver donor evaluation in our radiology department. Over a 6 year period, 132 donors were eligible for CT Hepatic angiography for possible living-donor liver transplantation (LDLT). The variations in branching pattern of main portal vein and segmental variation of right portal vein were classified according to Nakumura classification and classification proposed by Couinaud respectively. Results: Normal (Type A) anatomy was seen in 108 donors. (81.8%). Trifurcation (Type B) variation was seen in 14 cases (10.6%). Right posterior vein as first branch of MPV (Type C) variation was seen in 10 cases (7.57%). Type D variation and Type E variation were not seen our study. Eighty three (76.85%) of 108 donors with conventional MPV branching (type A) also had conventional RPV branching whereas 25 (23.1%) of these donors had variant RPV branching.
Conclusion:Variant portal vein anatomy is commoner than previously reported. Although anomalous anatomy is not always a contradiction for liver donation, its knowledge is critical in ensuring the safety of the donors and aids in selection of suitable candidates.
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