renal transplant related complications

Avascular

necrosis of the hip • Avascular necrosis of the femoral head - Ganzer Fall bei Radiopaedia

Gaillard F, Avascular necrosis of the femoral head. Case study, Radiopaedia.org (Accessed on 08 Dec 2022) https://doi.org/10.53347/rID-7579 • CC by-nc-sa 3.0 (modified)

Renal

transplant related complications • Large complicated lymphocele due to renal transplant - Ganzer Fall bei Radiopaedia

Niknejad M, Large complicated lymphocele due to renal transplant. Case study, Radiopaedia.org (Accessed on 06 Jan 2023) https://doi.org/10.53347/rID-21203 • CC by-nc-sa 3.0 (modified)

Renal

transplant related complications • Arteriovenous fistula - Ganzer Fall bei Radiopaedia

Radswiki T, Arteriovenous fistula. Case study, Radiopaedia.org (Accessed on 06 Jan 2023) https://doi.org/10.53347/rID-11208 • CC by-nc-sa 3.0 (modified)

Renal

transplant related complications • Perirenal transplant hematoma - Ganzer Fall bei Radiopaedia

Knipe H, Perirenal transplant hematoma. Case study, Radiopaedia.org (Accessed on 06 Jan 2023) https://doi.org/10.53347/rID-46245 • CC by-nc-sa 3.0 (modified)

Renal

transplant related complications • Transplant renal artery stenosis - Ganzer Fall bei Radiopaedia

Fortin F, Transplant renal artery stenosis. Case study, Radiopaedia.org (Accessed on 06 Jan 2023) https://doi.org/10.53347/rID-65971 • CC by-nc-sa 3.0 (modified)

Renal

transplant related complications • Avascular necrosis - Ganzer Fall bei Radiopaedia

Masters M, Avascular necrosis. Case study, Radiopaedia.org (Accessed on 06 Jan 2023) https://doi.org/10.53347/rID-38530 • CC by-nc-sa 3.0 (modified)

Radiopaedia • CC-by-nc-sa 3.0 • de

The recipients of renal transplants are susceptible to a number of complications. Incidence of each is variable and partially subject to specific surgical transplantation techniques and management patterns.

Pathology

Renal transplant complications

These can be broadly categorized as perirenal, renal parenchymal, renal collecting system, and/or renal vascular complications :

perioperative acute tubular necrosis
renal allograft compartment syndrome
renal allograft torsion (rare)
renal transplant rejection
- acute renal transplant rejection
- chronic renal transplant rejection
renal arterial stenosis in the transplant renal artery :
- peak systolic velocity (PSV) >200 cm/s
- 2:1 PSV ratio between stenotic and prestenotic artery
- spectral broadening distally (i.e. turbulent flow)
- +/- renal parenchymal tardus-parvus waveform
renal vein thrombosis
acute perioperative renal artery thrombosis
arteriovenous fistula
perinephric fluid collection: occurring roughly in the order below post-surgery
- hematoma
- urinoma
- abscess
- lymphocele
renal artery pseudoaneurysm
urinary obstruction
- although usually presents within the first 6 months following the transplant, may occur years later
- clinically presents with rising creatinine and absence of renal colic (renal allograft is denervated)
- site of obstruction is typically near transplant ureter / native bladder anastomosis
- causes of obstruction
  - transplant ureter stenosis (most commonly due to scarring, kinking, or secondary to anastomotic technique)
  - less commonly pelvic fibrosis, calculi, papillary necrosis, external compression
graft pyelonephritis
infections :
- nosocomial and procedure-related
  - occurring <1 month after transplantation
  - donor related infections: HSV, rabies, West Nile virus
  - recipient acquired infections: Aspergillus spp., Pseudomonas spp.
- latent, prior and opportunistic
  - occurring 1-6 months after transplantation
  - depending if the patient is on pneumocystis pneumonia and antiviral prophylaxis
  - with: BK virus, HCV, adenovirus, influenza, Cryptococcus neoformans, Mycobacterium tuberculosis
  - without: Pneumocystis jirovecii, Herpes family, HBV, Listeria, Nocardia, Toxoplasma spp.
- community-acquired
  - occurring >6 months after transplantation
  - urinary tract infection, late viral infections and others (e.g. Nocardia, Aspergillus)
donor-related malignancy