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Renal transplant vascular complications: the role of Doppler ultrasound

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Abstract

Improvements in the care of kidney transplant recipients and advances in immunosuppressive therapy have reduced the incidence of graft rejection. As a result, other types of kidney transplant complications, such as surgical, urologic, parenchymal, and vascular complications, have become more common. Although vascular complications account for only 5–10 % of all post-transplant complications, they are a frequent cause of graft loss. Ultrasonography, both in B-mode and with Doppler ultrasound, is a fundamental tool in the differential diagnosis of renal allograft dysfunction. Doppler ultrasound is highly specific in cases of transplanted renal artery stenosis, pseudoaneurysms, arteriovenous fistulas, and thrombosis with complete or partial artery or vein occlusion. A single measurements of color Doppler indexes display high diagnostic accuracy and in particular cases are more useful during the post-transplantation follow-up period. More recent techniques, such as contrast-enhanced ultrasound, undoubtedly increase the accuracy of ultrasonography in the diagnosis of vascular complications involving the transplanted kidney.

Riassunto

La progressiva riduzione dell’incidenza del rigetto ha reso più frequenti le complicanze urologiche, chirurgiche, parenchimali e vascolari. Queste ultime, pur rappresentando soltanto il 5–10 % di tutte le complicanze post-trapianto, sono frequente causa di perdita del graft. L’esame ultrasonografico, sia in B-mode che con l’ausilio del color Doppler, è fondamentale nella diagnosi differenziale delle cause che possono innescare una disfunzione del graft. Sebbene sia ormai indiscussa la sua utilità nella diagnosi di complicanze parenchimali, chirurgiche e urologiche, non è ancora consolidato il suo ruolo in caso di complicanze a carico dell’asse vascolare renale. L’ecocolor-Doppler, in particolare, possiede una specificità tale da poter essere considerato uno strumento diagnostico nella maggior parte delle complicanze vascolari del rene trapiantato, sia acute (occlusione parziale o totale dei vasi renali) che croniche (stenosi dell’arteria renale, pseudo aneurisma e fistola artero-venosa) Gli indici color-Doppler possiedono, infatti, una alta accuratezza diagnostica nella loro singola determinazione, risultando in casi particolari più utili nel follow-up. L’utilizzo di tecniche più moderne, come il mezzo di contrasto ecografico, consente indubbiamente di aumentare l’accuratezza diagnostica dell’esame ultrasonografico nel caso delle complicanze vascolari del rene trapiantato.

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Conflict of interest

Antonio Granata, Silvia Clementi, Francesco Londrino, Giulia Romano, Massimiliano Veroux, Fulvio Fiorini, Pasquale Fatuzzo declare that they have no conflict of interest.

Human and animal studies

The study described in this article did not include any procedures involving humans or animals.

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Authors and Affiliations

  1. Nephrology and Dialysis Unit, “St. Giovanni di Dio” Hospital, Agrigento, Italy

    Antonio Granata

  2. Medical Oncology Unit, Humanitas, Centro Catanese di Oncologia, Catania, Italy

    Silvia Clementi

  3. Nephrology and Dialysis Unit, “St. Andrea” Hospital, La Spezia, Italy

    Francesco Londrino

  4. Internal Medicine Unit, AOU “Vittorio Emanuele, Policlinico”, Catania, Italy

    Giulia Romano

  5. Vascular Surgery and Organ Transplant Unit, University Hospital of Catania, Catania, Italy

    Massimiliano Veroux

  6. Nephrology and Dialysis Unit, “Santa Maria della Consolazione” Hospital, Rovigo, Italy

    Fulvio Fiorini

  7. Cattedra di Nefrologia, Scuola di Specializzazione in Nefrologia, University Hospital of Catania, Catania, Italy

    Pasquale Fatuzzo

  8. Via F. Paradiso n°78/a, 95024, Acireale (CT), Italy

    Antonio Granata

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  1. Antonio Granata
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  2. Silvia Clementi
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  3. Francesco Londrino
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  4. Giulia Romano
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  5. Massimiliano Veroux
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  6. Fulvio Fiorini
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  7. Pasquale Fatuzzo
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Correspondence to Antonio Granata.

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Granata, A., Clementi, S., Londrino, F. et al. Renal transplant vascular complications: the role of Doppler ultrasound. J Ultrasound 18, 101–107 (2015). https://doi.org/10.1007/s40477-014-0085-6

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  • DOI: https://doi.org/10.1007/s40477-014-0085-6

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