Although the introduction of calcineurin inhibitors (cyclosporine and tacrolimus) has dramatically reduced the rate of acute allograft rejection, these drugs are nephrotoxic at supratherapeutic levels [4]. Toxicity is most common in the second or third month after transplantation, when the drugs are being titrated [5]. Chronic rejection is the most common cause of late graft dysfunction and presents at least 3 months following transplantation. Like intrinsic renal dysfunction, vascular complications and peri-transplant collections are most often encountered during specific postoperative time periods. Renal artery thrombosis (RAT) and renal vein thrombosis (RVT) usually occur in the first week after transplantation. They are usually the result of technical surgical difficulties and/or clotting disorders [6]. Renal artery stenosis (RAS) is the most common vascular complication, with an incidence of 1% to 2% [6,7]. Although it can occur at any time, RAS usually presents between 3 months and 24 months following transplantation. Peri-graft collections occur in up to 50% of patients following transplantation [8]. Seromas and hematomas generally occur in the first week following surgery. Abscesses and urinomas usually occur 1 to 3 weeks after transplantation. Lymphoceles typically present 1 to 2 months after transplantation [9]. Radiology plays a critical role in the diagnosis and management of renal transplant dysfunction. Ultrasound (US) is the modality of choice to evaluate renal transplants early in the postoperative period, in the post-transplant period, and also for long-term follow-up. US is also used to guide diagnostic and therapeutic interventions, such as biopsy, nephrostomy placement, and fluid aspiration. Radionuclide imaging is a modality capable of assessing 1Principal Author, George Washington University Hospital, Washington, District of Columbia. 2Panel Vice-chair, Northwestern University, Chicago, Illinois. 3Rhode Island Hospital, Providence, Rhode Island.
Renal Transplant Dysfunction. Although the introduction of calcineurin inhibitors (cyclosporine and tacrolimus) has dramatically reduced the rate of acute allograft rejection, these drugs are nephrotoxic at supratherapeutic levels [4]. Toxicity is most common in the second or third month after transplantation, when the drugs are being titrated [5]. Chronic rejection is the most common cause of late graft dysfunction and presents at least 3 months following transplantation. Like intrinsic renal dysfunction, vascular complications and peri-transplant collections are most often encountered during specific postoperative time periods. Renal artery thrombosis (RAT) and renal vein thrombosis (RVT) usually occur in the first week after transplantation. They are usually the result of technical surgical difficulties and/or clotting disorders [6]. Renal artery stenosis (RAS) is the most common vascular complication, with an incidence of 1% to 2% [6,7]. Although it can occur at any time, RAS usually presents between 3 months and 24 months following transplantation. Peri-graft collections occur in up to 50% of patients following transplantation [8]. Seromas and hematomas generally occur in the first week following surgery. Abscesses and urinomas usually occur 1 to 3 weeks after transplantation. Lymphoceles typically present 1 to 2 months after transplantation [9]. Radiology plays a critical role in the diagnosis and management of renal transplant dysfunction. Ultrasound (US) is the modality of choice to evaluate renal transplants early in the postoperative period, in the post-transplant period, and also for long-term follow-up. US is also used to guide diagnostic and therapeutic interventions, such as biopsy, nephrostomy placement, and fluid aspiration. Radionuclide imaging is a modality capable of assessing 1Principal Author, George Washington University Hospital, Washington, District of Columbia. 2Panel Vice-chair, Northwestern University, Chicago, Illinois. 3Rhode Island Hospital, Providence, Rhode Island.