Multimodality Radiological Diagnosis of Post Renal Transplantation Complications
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- Category: Vol. 90, December 2022
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Multimodality Radiological Diagnosis of Post Renal Transplantation Complications, IBRAHIM EL GAML, HOSSAM GAD, BASMA GAD ELHAK and MOHAMED ABOELATA
Abstract
Background: Renal transplantation is the most effective treatment option in patients with end-stage renal disease. Studies have shown that the 5-year survival after renal trans-plantation is 70%, as compared to 30% survival in patients receiving dialysis.For precise planning, early detection of problems, and workflow effectiveness, it is essential to adopt the proper diagnostic technique in preoperative analysis and also in postoperative follow-up procedure.
Aim of Study: To detect the of renal transplant complica-tions by MRI and/or renal scintigraphy compared to renal biopsy in a selected cases.
Patients and Methods: This study involved 90 renal transplant patients. There were 63 (70%) male patients and 27 (30%) female patients. They varied in age from 24 to 45 years (mean age 34.5 years). These 90 patients were subdivided into three groups as patients of medical complication (30 patients), patients of surgical complications (30 patients) and Control group of thirty recipient patients. Gray scale Ultra-sonography and color Doppler Sonography Applied routinely on all examined transplant recipients. These subjects have been assessed via MRI using 3 Tesla MRI scanner, (Philips, Ingenia).
Radio-isotope diuretic renogram by Philips Gamma Cam-era using Tc99-DTPA radioactive tracer. Performed routinely after 2 weeks from transplantation to all cases as basal study.
Results: Study included 90 transplant recipients. That were subdivided into three groups, Group of medical compli-cation Their ages ranged from 20-41 years mean (30.67±9.95) & group of surgical complication; their ages ranged from 23- 44 mean (33.90±10.88) and the control group includes 30 transplant recipients normal subjects, their ages ranged from 23-43 years mean (33.47±9.67). Males represented 76.7% and females represented 7% of patients with medical compli-cations. Males represented 73.3% and females represented 26.7% of patients with surgical complications. Males repre-sented 60% and females represented 40% of patients with normal transplanted kidney functions.
There is statistically significant lower mean ADC among medical complications than control groups (1.71 versus 2.02, respectively) without statistically significant difference between control, surgical complications (p=0.153) and between medical & surgical complications (p=0.172).
There is statistically significance as higher mean GFR isotope among cases with surgical complications than cases with medical complications (72.28 & 59.82, p=0.01). Per-fusion phase illustrates statistically significant difference between studied groups; with higher frequency of reduced perfusion among cases with medical than cases with surgical complications.
Conclusion: There was a significant decrease in the graft ADC map in cases with medical complication (ATN and Acute rejection) than control group.
Estimated GFRVia using Tc99-DTPA radioactive tracer renal scintigraphy showed statistical significant low at case of medical complication in comparison to control group & group of surgical complications.
Renal scintigraphy and DWI MRI provide noninvasive methods for detection of renal allograft dysfunction.