renal transplant complicatons copy
TRANSCRIPT
• Urologic complications occur in 4%–8% of patients, and vascular complications occur in approximately 1%–2% .
• Urologic Complications:• Urine Leak and Urinomas• rare complications.• Extravasation of urine may occur from the renal pelvis, ureter,
or ureteroneocystostomy site. • Urinomas vary in size and common during first 2
postoperative weeks.• Can be seen in rare sites such as the scrotum or thigh
• ULTRASOUND• well-defined, anechoic fluid collection with no septations that increases in size
rapidly.• Radionuclide scan: • extravasation of radiotracer • Delayed scintigrams should be obtained, since accumulation of radiotracer may
be slow.• Antegrade pyelography: • site of origin of the urinoma and in planning appropriate intervention.• Differential diagnosis:• seroma or lymphocele• Rx:• Drainage and Ureteral stents must be kept in place for 6–8 weeks after cessation
of leakage.
• Urinary obstruction :• 2% of transplantations and common in first 6 months.
• Most frequent site - implanted ureter into the bladder.
• Rx:• Percutaneous nephrostomy to relieve obstruction and ureteral stent placement and balloon ureteroplasty to be done.
• Percutaneous nephrostomy is used to relieve obstruction and allow the deployment of other radiologic interventions such as ureteral stent placement and balloon ureteroplast
• Peritransplant Fluid Collections:• It includes urinomas , hematomas, lymphoceles and
abscesses.• Occurs in upto 50% of transplantations.• Urinomas and hematomas - immediately.• lymphoceles - 4–8 weeks.
• Hematoma: • USG:• Acute hematoma - echogenic.• Older hematoma - even appear anechoic, more closely resembling fluid and septations. • CT: acute hematoma - high-attenuation components• older hematoma - liquefied and serous portions of intermediate attenuation • MRI: acute hematoma - show high signal intensity with both T1 and T2
• Lymphoceles:• common peritransplant fluid collections with a prevalence of 0.5%–20%.
• They may develop at any time, from weeks to years after transplantation.
• US, lymphoceles are anechoic and may have septations. Similar to other peritransplant fluid collections, they can become infected and can develop a more complex appearance (Fig 8). At CT, lymphoceles have variable characteristics and are usually sharply circumscribed. Their CT attenuation values are typical of those of water and usually lower than those of recent hematomas and abscesses. Radionuclide and MR imaging studies are helpful for excluding the presence of urine and blood, respectively.