MP32-02 UTILITY OF CONTRAST ENHANCED ULTRASOUND IN THE DIAGNOSIS OF ACUTE COMPLICATIONS AFTER RENAL TRANSPLANT.

Abstract

You have accessJournal of UrologyTransplantation & Vascular Surgery: Renal Transplantation & Vascular Surgery II1 Apr 2016MP32-02 UTILITY OF CONTRAST ENHANCED ULTRASOUND IN THE DIAGNOSIS OF ACUTE COMPLICATIONS AFTER RENAL TRANSPLANT. Sara Alvarez Rodriguez, Enrique Sanz Mayayo, Victoria Gómez Dos Santos, Vital Hevia Palacios, Rafael Rodríguez-Patrón Rodríguez, Víctor Díez Nicolas, and Javier Fabuel Alcañiz Sara Alvarez RodriguezSara Alvarez Rodriguez More articles by this author , Enrique Sanz MayayoEnrique Sanz Mayayo More articles by this author , Victoria Gómez Dos SantosVictoria Gómez Dos Santos More articles by this author , Vital Hevia PalaciosVital Hevia Palacios More articles by this author , Rafael Rodríguez-Patrón RodríguezRafael Rodríguez-Patrón Rodríguez More articles by this author , Víctor Díez NicolasVíctor Díez Nicolas More articles by this author , and Javier Fabuel AlcañizJavier Fabuel Alcañiz More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.1297AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Routine diagnostic method for assess renal graft dysfunction is Doppler ultrasound. However, contrast enhanced ultrasound (CEUS) may provide more information about evaluation of parenchymal flow and vascular status of kidney allografts. The objective was to evaluate the potential application of CEUS in the immediate post-transplant period, focused on acute vascular complications. METHODS A total of 15 kidney recipients underwent CEUS and conventional Doppler ultrasound 2-4 days after transplantation. After injection of 2.5 cc of intravenous contrast we analysed intensity curves (TIC) placing three circular regions of interest (ROIs) in the medullary region, interlobar arteries and subcapsular cortex. Initial baseline analysis was performed, and TIC parameters were correlated with clinical data and results from computed tomography and gammagraphy if available. In case of biopsy or transplantectomy, pathological specimens were also analysed. Analysed parameters on CEUS were: Arrival time (time to injection to start of micro bubble uptake in seconds)(At); Time to peak (TTP) of maximum value; Intensity peak of enhancement (IP) and final intensity (FI). Difference between IP and FI was calculated to evaluate the slope of the intensity curve. Parameters were always analysed in the three areas of interest described. Macroscopic visual evaluation of renal parenchyma vascularization. RESULTS 15 kidney recipients were included, including one living donor kidney, one autotrasplant and one orthotopic transplant. 2 patients showed reduced intensity curves consistent with acute tubular necrosis. 1 infectious abscess seen as an anechoic area without contrast uptake. 2 cortical necrosis showed an anechoic cortical halo, that cannot be detected by conventional US and that results were similar to those of the computed tomography (CT) with absence of allograft perfusion. 1 patient had a renal vein thrombosis and 1 patient a focal ischemic area due to thrombosis of a polar artery. Ischemic areas appeared as a perfusion defect, reflecting the lack of contrast uptake. Patients with cortical necrosis and venous thrombosis underwent immediate transplantectomy, and pathological analysis confirmed CEUS findings. The slope in allografts without evidence of acute complication was steeper identifying a better washout of contrast CONCLUSIONS CEUS is a useful tool in the characterization of renal graft dysfunction with special interest on acute vascular complications after renal transplant. It is a feasible technique for quantitative analysis of kidney perfusion which provides information on renal tissue microcirculation and regional parenchymal flow. Findings are superimposable to those in CT and this could be replaced in patients in the immediate post-transplant period avoiding nephrotoxic effect of iodinated agents. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e428 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Sara Alvarez Rodriguez More articles by this author Enrique Sanz Mayayo More articles by this author Victoria Gómez Dos Santos More articles by this author Vital Hevia Palacios More articles by this author Rafael Rodríguez-Patrón Rodríguez More articles by this author Víctor Díez Nicolas More articles by this author Javier Fabuel Alcañiz More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...