Renal transplant vascular complications: the role of Doppler ultrasound

Basile, Antonio; Clementi, Silvia; Lotti, Francesco; Romano, Giulia; Veroux, Massimiliano; Fiorini, Fulvio; Fatuzzo, Pasquale

doi:10.1007/s40477-014-0085-6

Cited by 66 publications

(62 citation statements)

References 26 publications

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“…Renal transplant surgery is often complicated by adverse haematological events such as bleeding and also intravesical thrombosis, both with a risk of renal allograft rejection 7. One earlier report described a renal transplantation in a patient with mild haemophilia that was complicated by the occurrence of an intravesicular bleeding resulting in an allograft rejection 8.…”

Section: Discussionmentioning

confidence: 99%

Pharmacokinetic-guided dosing of factor VIII concentrate in a patient with haemophilia during renal transplantation

et al. 2016

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A 29-year-old man with severe haemophilia A and end-stage renal disease underwent a renal transplantation. To prevent bleeding, patient was treated with replacement therapy using factor VIII (FVIII) concentrate, according to National guidelines. Bayesian analysis was performed by combining observed FVIII concentrations with a population pharmacokinetic (PK) model for patients with severe haemophilia A in a perioperative setting. Application of Bayesian analysis led to accurate prediction of observed concentrations after prescribing dosing advice. We believe that PK-guided dosing of factor concentrates is a valuable step towards further individualisation of treatment in patients with bleeding disorders, especially in those patients requiring precise targeting of coagulation factor levels due to high risk of either bleeding or thrombosis, as illustrated by this patient undergoing a major surgical procedure.

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Section: Discussionmentioning

confidence: 99%

Pharmacokinetic-guided dosing of factor VIII concentrate in a patient with haemophilia during renal transplantation

et al. 2016

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“…24 Conventional gray-scale ultrasonography with color and spectral Doppler is used immediately posttransplant for early detection of complications and evaluation of the renal allograft; it also allows calculation of resistive index and pulsatile index, which may predict early and long-term outcomes of noncomplicated renal transplants (Figure 1). 7,36,[37][38][39][40][41] It is noninvasive and is an easily available tool that avoids use of ionizing radiation and iodinated contrast media. It is generally considered safe in the hands of a trained and skilled operator.…”

Section: Clinical Manifestations Of Transplant Renal Vein Thrombosismentioning

confidence: 99%

“…Reversed or absent diastolic flow is a sign of extremely high vascular resistance in small intrarenal or large extrarenal vessels. 7,37,39,[42][43][44][45] This high vascular resistance indicates graft dysfunction and correlates with increased risk of graft loss. 39 The reversed diastolic waveform was described (in the main or segmental renal arteries), when retrograde blood flow occurred at any time point during the diastole, regardless of whether antegrade flow has happened.…”

Section: Clinical Manifestations Of Transplant Renal Vein Thrombosismentioning

confidence: 99%

“…[2][3][4][5][6] The most common vascular complications include transplant renal artery stenosis, renal graft arterial or venous thrombosis, and arterial injury, including arteriovenous fistulas, intrarenal pseudoaneurysms, arterial dissection, and arterial-calyceal fistulas. [5][6][7] Transplant renal vein thrombosis (TRVT) of an allograft has a dramatic clinical presentation and is one of the main causes of early graft dysfunction after renal transplant, with a reported prevalence of 0.1% to 4.2 % of all transplants. 2,[8][9][10][11] Transplant renal vein thrombosis events lead to graft loss and nephrectomy in almost all cases.…”

Section: Introductionmentioning

confidence: 99%

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Zorkany

Bridson²,

Sharma³

et al. 2017

Exp Clin Transplant

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Transplant renal vein thrombosis usually occurs early after surgery with a reported prevalence of 0.1% to 4.2%. It is a devastating event that ultimately leads to graft loss in almost all cases. There are many predisposing factors related to donor, recipient, surgery, and immunosuppression, with mechanical factors being considered the most common causes of transplant renal vein thrombosis. The clinical manifestations of acute renal vein thrombosis are nonspecific and are not dissimilar to the features of urine leak, urinary obstruction, or severe acute rejection. The diagnosis of transplant renal vein thrombosis depends on a high index of clinical suspicion and duplex ultrasonographic scans. Although venography remains the criterion standard, this procedure is invasive and nephrotoxic, due to use of ionizing contrast agents and also due to exposure to ionizing radiation. There are 2 therapies that have been described in the literature for salvaging a renal allograft with transplant renal vein thrombosis: thrombolytic therapy and surgical thrombectomy. The usual end result is renal allograft nephrectomy because the diagnosis is almost always too late.

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“…28 Transplant physicians should have theoretical and practice expertise in Doppler ultrasonography for early detection of such complications. 29 It has been reported that prompt revascularization could allow for graft salvage. 30 In our study, infections were the leading cause of morbidity and mortality throughout follow-up.…”

Section: Figure 1 Patient and Graft Survivalmentioning

confidence: 99%

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Abderrahim

Zammouri²,

Bacha³

et al. 2017

Exp Clin Transplant

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Objectives: The aim of this study was to report the results of 30 years of experience at the first kidney transplant center in Tunisia. Materials and Methods: All kidney transplants performed at the center between June 1986 and June 2016 were included. The study period was divided into 3 decades. Recipient and donor data and follow-up information were obtained from a local database and patient medical records. Comparative analyses were performed using the t test for continuous variables and the χ 2 test for qualitative variables. Patient and graft survival rates were calculated according to the actuarial method, and comparison of survival curves was performed according to the logrank test. Results: The mean age of recipients was 32.7 ± 11.5 years (range, 6-65 y) with a gender ratio of 2.2. Duration of prekidney transplant dialysis varied from 2 months to 20 years (median, 27.5 mo); 1.7% of patients underwent transplant preemptively. Kidneys were recovered from deceased donors in 21.2% of cases and from living donors in 78.8%. The proportion of deceased donors dropped from 27.4% during the period 2006-2010 to 12.9% during the period 2011-2015 (P < 0.04). Patient survival rates at 1, 5, 10, 15, and 20 years were 96%, 89.3%, 79.5%, 71.1%, and 65.4%. Graft survival rates were 95%, 86.5%, 76.2%, 66.3%, and 57.2%. The annual graft loss was 2.9%, with a mortality rate of 2.4% and without significant differences between patients receiving deceaseddonor and living-donor organs. Conclusions: Kidney transplant activity remains suboptimal in our country. The reduction in deceaseddonor organs could be related to the political transformations facing our country with their resulting social and economic consequences. Efforts should be made to increase governmental resources and to improve both public awareness of organ donation and the motivation of transplant teams.

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Renal transplant vascular complications: the role of Doppler ultrasound

Cited by 66 publications

References 26 publications

Pharmacokinetic-guided dosing of factor VIII concentrate in a patient with haemophilia during renal transplantation

Pharmacokinetic-guided dosing of factor VIII concentrate in a patient with haemophilia during renal transplantation

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