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The prevalence and significance of renal perfusion defects in early kidney transplants quantified using 3D contrast enhanced ultrasound (CEUS)

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Vascular complications are one of the most common causes of early kidney transplant dysfunction. Contrast enhanced ultrasound increases sensitivity to vascular changes. The aim of this study was to assess the prevalence and size of vascular abnormalities in early renal transplants using 3D CEUS and the significance of perfusion defects on renal function.


Ninety-nine renal transplant patients underwent 3D CEUS after surgery to quantify perfusion defects as percentage total renal volume (TRV). Serum creatinine and estimated glomerular filtration rate (eGFR) were recorded up to 3 months post-surgery.


Twenty participants had focal perfusion defects (0.2–43%TRV). There was a meaningful difference in patients with perfusion defects in eGFR at 1 month (90% CI 2.7–19.2 mL/min/1.73 m2) and 3 months (90% CI 1.9-19.6 mL/min/1.73 m2) and creatinine at 3 months (90% CI -56 – -8 μmol/L) using a predetermined clinical threshold. Perfusion defect size correlated well with both serum creatinine and eGFR at 3 months (R = 0.80, p ≤ 0.000 and 0.58, p = 0.038). No correlation was seen prior to 3 months.


Perfusion defects in kidney transplants were more common than expected and were highly likely to reduce renal function at 1-3 months, and the size of the defect affected the degree of functional change at 3 months.

Key Points

Perfusion defects were more common than previously thought.

Perfusion defects could be quantified using 3D CEUS.

The presence of even small perfusion defects may affect kidney function.

Size of perfusion defects correlated with subsequent kidney function at 3 months.

Potentially useful in informing clinician expectations of kidney function post-surgery.

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Hardware and software support was provided by Philips Healthcare.

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Corresponding author

Correspondence to Ben Stenberg.

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The scientific guarantor of this publication is Prof Nick Caplan.

Conflict of interest

The authors of this manuscript declare relationships with the following companies: Philips Healthcare.


This study has received funding by College of Radiographers Industrial Partnership Scheme, The Northern Counties Kidney Research Fund and The Newcastle upon Tyne Special Trustees Charity.

Statistics and biometry

One of the authors has significant statistical expertise.

Ethical approval

Institutional Review Board approval was obtained.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Study subjects or cohorts overlap

Some study subjects or cohorts have been previously reported in Stenberg B, Chandler C, Wyrley-Birch, Elliott ST, Post-Operative 3-Dimensional Contrast-Enhanced Ultrasound (CEUS) Versus Tc99m-DTPA in the Detection of Post-Surgical Perfusion Defects in Kidney Transplants – Preliminary Findings. Ultraschall in Med. 2014; 35 (3): 273-8.


• prospective

• diagnostic or prognostic study

• performed at one institution

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Stenberg, B., Wilkinson, M., Elliott, S. et al. The prevalence and significance of renal perfusion defects in early kidney transplants quantified using 3D contrast enhanced ultrasound (CEUS). Eur Radiol 27, 4525–4531 (2017).

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