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Semin intervent Radiol 2001; 18(1): 047-058
DOI: 10.1055/s-2001-12838
Copyright © 2001 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

Interventional Radiological Management of the Complications of Renal Transplantation

Stephen P. Johnson, Robert S. Berry
  • University of Colorado Health Sciences Center, Denver, Colorado
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Publication History

Publication Date:
31 December 2001 (online)

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ABSTRACT

This article outlines the diagnosis and management of complications of renal transplantation. This includes lymphocele urinomas and a variety of vascular problems.

KEYWORD

Kidney - transplantation - interventional procedure - renal arteries - stenosis - obstruction

REFERENCES

  • 1 Irving H C, Kashi S H. Complications of renal transplantation and the role of interventional radiology.  J Clin Ultrasound . 1992;  20 545-552
    CrossrefPubMedSearch in Google Scholar
  • 2 Silver T M, Campbell D, Wicks J D. Peri-transplant fluid collections.  Radiology . 1981;  138 145-151
    PubMedSearch in Google Scholar
  • 3 Pollak R, Vernis S A, Maddux M S. The natural history of and therapy for perirenal fluid collections following renal transplant.  J Urol . 1988;  140 716-720
    PubMedSearch in Google Scholar
  • 4 Shokeir A A, el-Diasty T A, Ghoneim M A. Percutaneous treatment of lymphocele in renal transplant recipients.  J Endourol . 1993;  7 481-458
    PubMedSearch in Google Scholar
  • 5 Smith T P, Cragg A H. Nonvascular interventional radiologic procedures after renal transplantation. In: Letourneau JG, Daty DL, Ascher NL, eds. Radiology of Organ Transplantation St. Louis: Mosby Year Book; 1991
    Search in Google Scholar
  • 6 Zuckerman D A, Yeager T D. Percutaneous ethanol sclerotherapy of postoperative lymphoceles.  AJR Am J Roentgenol . 1997;  169 433-437
    CrossrefPubMedSearch in Google Scholar
  • 7 Cohan R H, Saeed M, Sussman S K. Percutaneous drainage of pelvic lymphatic fluid collections in the renal transplant patient.  Invest Radiol . 1987;  22 864-867
    PubMedSearch in Google Scholar
  • 8 Kim J K, Jeong Y Y, Kim Y H. Postoperative pelvic lymphocele: treatment with simple percutaneous catheter drainage.  Radiology . 1999;  212 390-394
    PubMedSearch in Google Scholar
  • 9 Gilliland J D, Spies J B, Brown S B. Lymphoceles: percutaneous treatment with povidone-iodine sclerosis.  Radiology . 1989;  171 227-229
    PubMedSearch in Google Scholar
  • 10 Sawhney R, D'Augostino H B, Zincks A. Treatment of postoperative lymphoceles with percutaneous drainage and alcohol sclerotherapy.  J Vasc Interv Radiol . 1996;  7 241-245
    CrossrefPubMedSearch in Google Scholar
  • 11 Montalvo B M, Yrizarry J M, Casillas V J. Percutaneous sclerotherapy of lymphoceles related to renal transplantation.  J Vasc Interv Radiol . 1996;  7 117-123
    CrossrefPubMedSearch in Google Scholar
  • 12 Folk J J, Musa A G. Management of persistent lymphocele by sclerotherapy with doxycycline.  Eur J Obstet Gynecol Reprod Biol . 1995;  60 191-193
    CrossrefPubMedSearch in Google Scholar
  • 12a Akhan O, Cekirage S, Ozmen M, Besim A. Percutaneous transcatheter ethanol sclerotherapy of postoperative pelvic lymphoceles.  Cardiovasc Intervent Radiol . 1992;  15 224-227
    PubMedSearch in Google Scholar
  • 12b Rivera M, Marcen R, Burgos J. Treatment of posttransplant lymphocele with providone-iodine sclerosis: long-term follow-up.  Nephron . 1996;  74 324-327
    PubMedSearch in Google Scholar
  • 13 Gonzalez Martin M, Duarte Novo E J, Gomez Veiga F. Marsupialization via minilaparotomy in the kidney transplant.  Arch Esp Urol . 1999;  52 41-46
    PubMedSearch in Google Scholar
  • 14 Gill I S, Hodge E E, Munch L C. Transperitoneal marsupialization of lymphoceles: a comparison of laparoscopic and open techniques.  J Urol . 1995;  153 706-711
    CrossrefPubMedSearch in Google Scholar
  • 15 Schweizer R T, Barkus S A, Foster J H. Treatment of pelvic lymphoceles after renal transplantation by intraperitoneal marsupialization.  Am Surg . 1976;  42 316-318
    PubMedSearch in Google Scholar
  • 16 Shaver T R, Swanson 3rd J S, Fernandez-Bueno C, Kocandrle V. The optimal treatment of lymphoceles following renal transplantation.  Transpl Int . 1993;  6 108-110
    CrossrefPubMedSearch in Google Scholar
  • 17 Gruessner R W, Fasda C, Benedetti E. Laparoscopic drainage of lymphoceles after kidney transplantation: indications and limitations.  Surgery . 1995;  117 288-295
    PubMedSearch in Google Scholar
  • 18 Melvin W S, Bumgardner G L, Davies E A. The laparoscopic management of post-transplant lymphocele. A critical review.  Surg Endosc . 1997;  11 245-248
    CrossrefPubMedSearch in Google Scholar
  • 19 Thurlow J P, Gelpi J, Schwaitzberg S D, Rohrer R J. Laparoscopic peritoneal fenestration and internal drainage of lymphoceles after renal transplantation.  Surg Laparosc Endosc . 1996;  6 290-295
    CrossrefPubMedSearch in Google Scholar
  • 20 Cadrobbi R, Zanietto G, Rigotti P. Laparoscopic treatment of lymphocele after kidney transplantation.  Surg Endosc . 1999;  13 985-990
    CrossrefPubMedSearch in Google Scholar
  • 21 Bischof G, Rockenschaub S, Berlakavich G. Management of lymphoceles after kidney transplantation.  Transpl Int . 1998;  11 277-280
    CrossrefPubMedSearch in Google Scholar
  • 22 Schurawitzki H, Karnel F, Mostbeck G. Radiologic therapy of symptomatic lymphoceles following kidney transplantation.  Rofo Fortschr Geb Rontgensr Neuen Bildgeb Verfahr . 1990;  152 71-75
    PubMedSearch in Google Scholar
  • 23 Kerlan Jr K R, LaBerge J M, Gordon R L, Ring E J. Bleomycin sclerosis of pelvic lymphoceles.  J Vasc Interv Radiol . 1997;  8 885-887
    CrossrefPubMedSearch in Google Scholar
  • 24 Bischof G. Management of lymphoceles after kidney transplantation.  Transpl Int . 1998;  11 277-280
    CrossrefPubMedSearch in Google Scholar
  • 25 Vogelzang R L, Tobin R S, Burstein S. Transcatheter intracavitary fibrinolysis of infected extravascular hematomas.  AJR Am J Roentgenol . 1987;  148 378-380
    PubMedSearch in Google Scholar
  • 26 Barros D. Utility of fibrinolytics for draining intrapleural infections.  Semin Resp Infect . 1999;  14 39-47
    PubMedSearch in Google Scholar
  • 27 Lopes J A, de Almeida H C, Hachul M, Srougi M. Frequency of stenosis of the renal artery in 676 renal transplantations.  Rev Assoc Med Bras . 1998;  44 210-213
    PubMedSearch in Google Scholar
  • 28 al-Najjar A, Halimi J M, Buchler M. Transplant renal artery stenosis: long term effect of angioplasty on arterial pressure control and renal function.  Arch Mal Coeur Vaiss . 1998;  91 1073-1076
    PubMedSearch in Google Scholar
  • 29 Matalon T A, Thompson M J, Patel S K. Percutaneous transluminal angioplasty for transplant renal artery stenosis.  J Vasc Interv Radiol . 1992;  3 55-58
    PubMedSearch in Google Scholar
  • 30 Rengel M, Gomes-Da-Silva G, Inchaustegui L. Renal artery stenosis after kidney transplantation: diagnostic and therapeutic approach.  Kidney Int Suppl . 1998;  68 S99-106
    PubMedSearch in Google Scholar
  • 31 Fauchald P, Vatne R, Paulsen D. Long-term clinical results of percutaneous transluminal angioplasty in transplant renal artery stenosis.  Nephrol Dial Transplant . 1992;  7 256-259
    PubMedSearch in Google Scholar
  • 32 Merkus J W, Hurysmans F T, Hoitsma A J. Renal allograft artery stenosis: results of medical treatment and intervention. A retrospective analysis.  Transpl Int . 1993;  6 111-115
    PubMedSearch in Google Scholar
  • 33 Henricksson C, Nilson A E, Thoren O K. Artery stenosis in renal transplantation.  Scand J Urol Nephrol . 1975;  29S 89-90
    PubMedSearch in Google Scholar
  • 34 Thomas C P, Riad H, Johnson D F, Cumberland D C. Percutaneous transluminal angioplasty in transplant renal arterial stenoses: a long-term follow-up.  Transpl Int . 1992;  5 129-132
    CrossrefPubMedSearch in Google Scholar
  • 35 Raynaud A, Lucino S, de Almedida Augusto C M. Percutaneous endoluminal angioplasty of the transplanted kidney. Long-term follow-up.  J Radiol . 1994;  75 81-86
    PubMedSearch in Google Scholar
  • 36 Krajickova D, Peregrin J H, Stribrna J. Percutaneous transluminal angiography of the renal artery in transplanted kidneys.  Vnitr Lek . 1997;  43 775-780
    PubMedSearch in Google Scholar
  • 37 Sankari B R, Geisinger M, Zelch M. Post-transplant renal artery stenosis: impact of therapy on long-term kidney function and blood pressure control.  J Urol . 1996;  155 1860-1864
    PubMedSearch in Google Scholar
  • 38 Stanley P, Malekzadeh M, Diament M J. Posttransplant renal artery stenosis: angiographic study in 32 children.  AJR Am J Roentgenol . 1987;  148 487-490
    PubMedSearch in Google Scholar
  • 39 Serrallach N, Serrate R, Franco E. Renal artery stenosis in transplanted kidney: management and results in six patients.  Eur Urol . 1985;  11 31-35
    PubMedSearch in Google Scholar
  • 40 Pouria S, State O OI, Wong W, Hendry B M. CMV infection is associated with transplant renal artery stenosis.  QJM . 1998;  91 185-189
    CrossrefPubMedSearch in Google Scholar
  • 40a Lopes J A, de Almeida J C, Hachad M, Srougi M. Frequency of stenosis of the renal artery in 676 renal transplantations.  Dev Assoc Med Bras . 1998;  44 210-213
    PubMedSearch in Google Scholar
  • 40b Benoit G, Moukarzel M, Hiesse C. Arterial stenosis in the renal graft. Indication for endoluminal dilation.  Presse Med . 1991;  20 2045-2047
    PubMedSearch in Google Scholar
  • 41 Baxter G M, Ireland H, Moss J G. Colour Doppler ultrasound in renal transplant artery stenosis: which Doppler index?.  Clin Radiol . 1995;  50 618-622
    PubMedSearch in Google Scholar
  • 42 Neimatallah M A, Dong Q, Schoenberg S O. Magnetic resonance imaging in renal transplantation.  J Magn Reson Imaging . 1999;  10 357-368
    CrossrefPubMedSearch in Google Scholar
  • 43 Ferreiros J, Mandez R, Jorquera M. Using gadolinium-enhanced three-dimensional MR angiography to assess arterial inflow stenosis after kidney transplantation.  AJR Am J Roentgenol . 1999;  172 751-757
    PubMedSearch in Google Scholar
  • 44 Johnson D B, Lerner C A, Prince M R. Gadolinium-enhanced magnetic resonance angiography of renal transplants.  Magn Reson Imaging . 1997;  15 13-20
    PubMedSearch in Google Scholar
  • 45 Spinosa D J, Matsumoto A H, Angle J F. Gadolinium-based contrast and carbon dioxide angiography to evaluate renal transplants for vascular causes of renal insufficiency and accelerated hypertension.  J Vasc Interv Radiol . 1998;  9 909-916
    PubMedSearch in Google Scholar
  • 46 Zwaan M, Steinhoff J, Fricke L. The angiography of kidney transplant arteries using carbon dioxide.  Dtsch Med Wochenschr . 1997;  122 1133-1136
    PubMedSearch in Google Scholar
  • 47 Halimi J M, al-Najjir A, Buchler M. Transplant renal artery stenosis: potential role of ischemia/reperfusion injury and long-term outcome following angioplasty.  J Urol . 1999;  161 28-32
    PubMedSearch in Google Scholar
  • 48 Newman-Sanders A P, Gedroyc W G, al-Kutoubi M A. The use of expandable metal stents in transplant renal artery stenosis.  Clin Radiol . 1995;  50 245-250
    PubMedSearch in Google Scholar
  • 49 Lee G. Successful selective thrombolysis of a spontaneous transplant renal vein thrombosis.  BJU Int . 1999;  83 869-870
    CrossrefPubMedSearch in Google Scholar
  • 50 Ismail H, Kalicinski P, Drewniak T. Primary vascular thrombosis after renal transplantation in children.  Pediatr Transplant . 1997;  1 43-47
    PubMedSearch in Google Scholar
  • 51 Tamim W, Arous E. Thrombolytic therapy: the treatment of choice for iliac vein thrombosis in the presence of kidney transplant.  Ann Vasc Surg . 1999;  13 436-438
    CrossrefPubMedSearch in Google Scholar
  • 52 Chiu A S, Landsberg D N. Successful treatment of acute transplant renal vein thrombosis with selective streptokinase infusion.  Transplant Proc . 1991;  23 2297-2300
    PubMedSearch in Google Scholar
  • 53 Modrall J G, Teitelbaum G P, Diaz-Luna H, Berno T. Local thrombolysis in a renal allograft threatened by renal vein thrombosis.  Transplantation . 1993;  56 1011-1013
    PubMedSearch in Google Scholar
  • 54 Boschiero L B, Saggin P, Galate O. Renal needle biopsy of the transplant kidney: vascular and urologic complications.  Urol Int . 1992;  48 130-133
    PubMedSearch in Google Scholar
  • 55 Perini S, Gordon R L, LaBerge J M. Transcatheter embolization of biopsy-related vascular injury in the transplant kidney: immediate and long-term outcome.  J Vasc Interv Radiol . 1998;  9 1011-1019
    PubMedSearch in Google Scholar
  • 56 Baquero A, Morris M C, Cope C. Selective embolization of vascular complications following renal biopsy of the transplant kidney.  Transplant Proc . 1985;  17 1751-1754
    PubMedSearch in Google Scholar
  • 57 Irving H C, Kashi S H. Complications of renal transplantation and the role of interventional radiology.  J Clin Ultrasound . 1992;  20 545-552
    CrossrefPubMedSearch in Google Scholar
  • 58 Kashi S H, Lodge J P, Giles G R, Irving H C. Ureteric complications of renal transplantation.  Br J Urol . 1992;  70 139-143
    PubMedSearch in Google Scholar
  • 59 Mundy A R, Podesta M L, Bewick M, Rudge C J, Ellis F G. The urological complications of 1000 renal transplants.  Br J Urol . 1981;  53 397-402
    PubMedSearch in Google Scholar
  • 60 Loughlin K R, Tilney N L, Richie J P. Urologic complications in 718 renal transplant patients.  Surgery . 1984;  95 297-302
    PubMedSearch in Google Scholar
  • 61 Smith R B, Ehrlich R M. The surgical complications of renal transplantation.  Urol Clin North Am . 1976;  3 621-646
    PubMedSearch in Google Scholar
  • 62 Bennett L N, Voegeli D R, Crummy A B. Urologic complications following renal transplantation: role of interventional radiologic procedures.  Radiology . 1986;  160 531-536
    CrossrefPubMedSearch in Google Scholar
  • 63 Gottlieb R H, Voci S L, Cholewinski S P. Sonography: a useful tool to detect the mechanical causes of renal transplant dysfunction.  J Clin Ultrasound . 1999;  27 325-333
    CrossrefPubMedSearch in Google Scholar
  • 64 Kashi S H, Lodge J P, Giles G R, Irving H C. Ultrasonography of renal allografts: collecting system dilatation and its clinical significance.  Nephrol Dial Transplant . 1991;  6 358-362
    PubMedSearch in Google Scholar
  • 65 Jaffe R B, Middleton Jr W A. Whitaker test: differentiation of obstructive and non-obstructive uropathy.  Am J Roentgenol . 1980;  134 9-15
    PubMedSearch in Google Scholar
  • 66 Fontaine A B, Nijjar A, Rangaraj R. Update on the use of percutaneous nephrostomy/balloon dilation for the treatment of renal transplant leak/obstruction.  J Vasc Interv Radiol . 1997;  8 649-653
    CrossrefPubMedSearch in Google Scholar
  • 67 Lojanapiwat B, Mital D, Fallon L. Management of ureteral stenosis after renal transplantation.  J Am Coll Surg . 1994;  179 21-24
    PubMedSearch in Google Scholar
  • 68 Reinberg Y, Ferral H, Gonzalez R. Intraureteral metallic self-expanding endoprosthesis (Wallstent) in the treatment of difficult ureteral strictures.  J Urol . 1994;  151 619-622
    PubMedSearch in Google Scholar
  • 69 Anderson E E, Glenn J F, Siegler H F, Stickel D L. Ureteral implantation in renal transplantation.  Surg Gynecol Obstet . 1972;  134 494-496
    PubMedSearch in Google Scholar
  • 70 Palmer J M, Chatterjee S N. Urologic complications in renal transplantation.  Surg Clin North Am . 1978;  58 305-319
    PubMedSearch in Google Scholar
  • 71 Smith T P, Hunter D W, Letourneau J G. Urine leaks after renal transplantation: value of percutaneous pyelography and draining for diagnosis and treatment.  AJR Am J Roentgenol . 1988;  151 511-513
    PubMedSearch in Google Scholar
  • 72 Smolev J K, McLoughlin M G, Rolley R, Sterioff S, Williams G M. The surgical approach to urological complications in renal allotransplant recipients.  J Urol . 1977;  117 10-12
    PubMedSearch in Google Scholar
  • 73 Voegeli D R, Crummy A B, McDermott J C, Jensen S R, Montague T L. Percutaneous management of the urological complications of renal transplantation.  Radiographics . 1986;  6 1007-1022
    PubMedSearch in Google Scholar
  • 74 Orons P D, Zajko A B. Angiography and interventional aspects of renal transplantation.  Imaging Organ Transplantation . 1995;  33 461-474
    PubMedSearch in Google Scholar
  • 75 Van Gansbeke D, Matos C, Geverois P. Percutaneous interventional procedures in the management of urologic complications of renal transplantation.  Transplant Proc . 1987;  19 2205
    PubMedSearch in Google Scholar