Significance of elevated transplant renal artery velocities in the postoperative renal transplant patient

Siskind, E. J.; Lombardi, Pamela; Blum, Mark; Tyrell, Richard; Villa, Manuel; Kuncewitch, Michael; Olsen, Elizabeth M.; Alex, Asha; Lumermann, Leandro; Bhaskaran, Madhu; Jhaveri, Kenar D.; Sachdeva, Mala; Calderon, Kellie; Greben, Craig; Putterman, Daniel; Gandras, Eric J.; Caplin, Drew; Agostino, Catherine D’; Pellerito, John S.; Coppa, Gene F.; Molmenti, Ernesto P.

doi:10.1111/ctr.12075

Cited by 18 publications

(7 citation statements)

References 8 publications

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“…Along with renal artery measurements, the proximal and distal iliac vessels also need to be evaluated to compare the flow to the renal artery velocities. Elevated renal artery velocities in the immediate postoperative period do not necessarily represent stenosis requiring intervention because in most cases they normalize over time (3).…”

Section: Ultrasonographymentioning

confidence: 99%

Renal Relevant Radiology

Sharfuddin

2014

Clinical Journal of the American Society of Nephrology

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SummaryKidney transplantation can be associated with various complications that vary from vascular complications to urologic disorders to immunologic adverse effects. In evaluating the recipient with graft dysfunction, clinicians can choose among several imaging modalities, including ultrasonography, nuclear medicine studies, computed tomography, and magnetic resonance imaging. This review discusses the evaluation of the kidney transplant recipient using these imaging procedures, emphasizing the clinical diagnostic utility and role of each modality. A kidney biopsy is often required as a gold standard for diagnostic purposes. However, because of the inherent risks of a kidney biopsy, noninvasive imaging in diagnosing causes of graft dysfunction is a highly desired tool used and needed by the transplant community. Because the diagnostic accuracy varies depending on the time course and nature of the transplant-related complication, this review also addresses the advantages and limitations of each modality. The recent advances in kidney transplant imaging techniques and their clinical implications are also discussed.

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Section: Ultrasonographymentioning

confidence: 99%

Renal Relevant Radiology

Sharfuddin

2014

Clinical Journal of the American Society of Nephrology

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“…Transiently high PSVs in the early postoperative period are commonly attributed to anastomosis edema 13 ; however, if PSV elevation persists, it can lead to functional compromise of the graft. TRAS is the most common vascular complication after RT and is often suspected when PSV is above 200‐250 cm/s 14,15 . While our DUS results at 1 week show that the TA group was within this range, none of the patients in either group of this study required endovascular intervention, indicating that elevated PSV did not translate into a permanent vascular compromise or subsequent TRAS.…”

Section: Discussionmentioning

confidence: 60%

Vascular inflow after renal transplantation: Does the arteriotomy technique impact early allograft perfusion and function?

Keefe

Rickard

Manickavachagam

et al. 2020

Pediatric Transplantation

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Background: There are two main techniques for arterial reconstruction in RT: TA using a stab longitudinal incision which creates an elliptical opening and AP which fashions a circular defect. We hypothesized that AP creates a natural anastomosis lumen, similar to the donor renal artery, which optimizes RT perfusion. Methods: A retrospective review of a single-institution database was performed between 2000 and 2018. Twenty patients who underwent AP arteriotomy were compared to 40 TA-matched controls. Data were collected on creatinine (preoperative, nadir, and time to nadir), and DUS RI and PSV at 1 week, 3 months, and 6-12 months post-RT. Results: ttNC was shorter in the AP group (5 ± 4 vs 12 ± 13 days; P = .03). PSV at 1 week was lower in the AP group (186 ± 65 cm/s vs 232 ± 89 cm/s; P = .04). There was no difference in nadir creatinine value (P = .26), preoperative creatinine (P = .66), and initial postoperative creatinine (P = .80). RI at week 1 were not different between groups (P = .37). Follow-up DUS showed the difference in PSV between groups became non-significant (1 month P = .50 and 6-12 months P = .53). Conclusions: AP arteriotomy in RT improves early perfusion and function parameters (ttNC and initial PSV) as compared to TA. AP arteriotomy optimizes early allograft reperfusion, which may have important long-term implications and deserves further evaluation.

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“…Although the thrombus did not involve the allograft vein in three patients, it appears that it is the only culprit causing the injury. This is corroborated by transient worsening of calculated resistive indices, 11 in addition to the improvement in serum Cr concentration after therapy. All patients underwent laboratory evaluation for thrombophilic disorders; the result was negative in all cases.…”

Section: Discussionmentioning

confidence: 69%

Iliofemoral deep venous thrombosis in kidney transplant patients can cause graft dysfunction

Khalifeh

Reif

Tolayamat

et al. 2019

Journal of Vascular Surgery Cases, Innovations and Techniques

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We present a series of kidney transplant dysfunction secondary to lower extremity deep venous thrombosis (DVT). A 70-year-old man underwent living unrelated kidney transplantation and presented 2 months postoperatively with acute kidney injury (AKI) secondary to external iliac vein thrombosis. Graft function improved after endovascular intervention. A 43-year-old man underwent living unrelated kidney transplantation and presented 3 years postoperatively with AKI secondary to external iliac vein thrombosis. Graft function recovered after thrombolysis. A 42-year-old woman underwent simultaneous pancreas and kidney transplantation. Four weeks postoperatively, she had AKI secondary to common femoral vein DVT. Her graft function improved after common iliac vein stenting. A 67-year-old man underwent living unrelated kidney transplantation and presented a week later with lower extremity DVT and AKI. His graft function improved with anticoagulation. Iliofemoral DVT can cause allograft dysfunction. The cause may be multifactorial. Endovascular intervention is safe and feasible when anticoagulation fails.

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Significance of elevated transplant renal artery velocities in the postoperative renal transplant patient

Cited by 18 publications

References 8 publications

Renal Relevant Radiology

Renal Relevant Radiology

Vascular inflow after renal transplantation: Does the arteriotomy technique impact early allograft perfusion and function?

Iliofemoral deep venous thrombosis in kidney transplant patients can cause graft dysfunction

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