Who should have pelvic vessel imaging prior to renal transplantation?

Abstract

Current guidelines are vague in their recommendations as to which patients should be imaged prior to renal transplantation and the optimal imaging modality for this purpose. Data on 112 patients who underwent pre-transplant vascular imaging (magnetic resonance angiography or contrast angiography), from a total of 167 evaluated between January 2005 and October 2006, were scrutinized to see whether abnormal results altered clinical management. Several variables were analyzed to determine possible predictors of an abnormal scan result. Sixty-nine patients (61.6%) were either diabetic or aged over 60. Fifty-nine (52.7%) were normal scans, and 53 (47.3%) were abnormal. In the abnormal group, 21 (18.8%) clinical decisions were made. Multivariate analysis revealed that age (OR: 1.1, 1.03-1.13) and diabetes (OR: 3.2, 1.13-9.2) were significant predictors of an abnormal scan. Imaging delayed transplant listing by 83 days. Imaging for all potential transplant recipients is not required and results in unnecessary delay. Risk factors including age and diabetes can be utilized to rationalize imaging via clinical guidelines to target to high-risk groups. The choice of imaging modality in patients with renal insufficiency is not clear cut, but risks and benefits should be addressed on an individual basis and preventative strategies used whenever possible.

Simultaneous pancreas and kidney transplantation: Incidence and risk factors for amputation after 10‐year follow‐up

“…However, tacrolimus preserves endothelial function to prevent the development of intimal hyperplasia . Another potential hypothesis is a steal phenomenon caused by anastomosing the donor kidney and pancreas to the recipient's left and right common iliac arteries, respectively, as described by Sollinger et al . Northcutt et al .…”

Does kidney transplantation to iliac artery deteriorate ischemia in the ipsilateral lower extremity with peripheral arterial disease?

“…4 Transplant and vascular surgeons are concerned whether the blood flow diverting phenomenon occurs in adults following kidney transplantation, and subsequently causes deterioration of the limb ischemia in the patients with preexisting PAD. 3,5 As vascular surgeons, we are often consulted to perform peripheral vascular evaluation in renal transplant candidates for two main purposes: (1) To rule out significant aorto-iliac occlusive disease (AIOD) and reduce the risk of ischemia of a transplanted graft; (2) To assess the severity of lower extremity PAD and the possibility of ischemia deterioration due to blood steal by transplanted kidney.…”

“…1,2 One of the clinical concerns is the possibility of ischemia deterioration of the lower extremity with PAD due to blood diverting by a kidney transplanted to the iliac artery. 3 Acute limb ischemia due to steal phenomenon by graft kidney has been reported in pediatric patients. 4 The clinical significance of this “blood steal” phenomenon in adult patients with PAD has not been well documented, although it has been one of the main concerns during pre-transplantation evaluation.…”

“…4 The clinical significance of this “blood steal” phenomenon in adult patients with PAD has not been well documented, although it has been one of the main concerns during pre-transplantation evaluation. 3,5,6 Current guidelines of the evaluation of renal transplant candidates with PDA recommend surgical intervention if the PAD is symptomatic, but do not comment on patients with symptomatic PAD who are not candidates for revascularization because of diffuse distal arterial disease. 5 Therefore, the question arises whether renal transplantation will deteriorate limb ischemia, especially in symptomatic patients, and whether those patients should be excluded from the transplant waiting list.…”

Preoperative planning of renal transplantation: a comparison of non-contrast-enhanced ultrasonography, computed tomography, and magnetic resonance angiography with observations from surgery

“…Hence, many candidates for kidney transplantation need to undergo vessel examination before the transplantation procedure. Currently, there is no consensus regarding which imaging modality to use in patients with renal insufficiency (4). Clinical guidelines are vague and do not specify which imaging modality is preferable (5–7).…”