EN
BLOC RENAL TRANSPLANTATION :
RENOGRAPHIC APPEAREANCE
Article Nº AJ02-3
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Department
of *Nuclear Medicine and +Transplantation
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Cita/Reference: Neubauer, S. et al. En Bloc Renal Transplantation : Renographic Appearence. Alasbimn Journal1(2): december 1998. Article Nº AJ02-3. http://www.alasbimnjournal.cl/revistas/2/neubauer.htm |
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INTRODUCTION
In 1967 Kelly et al reported their poor results in five single pediatric kidneys transplanted to adults recipients (1). Two years later Martin (2) and others (3,4) published their experience transplanting both pediatric kidneys en bloc in children and adult recipients. Improvements in donor management, organ preservation, surgical implantation techniques and better antirejection therapies have increased graft survival and decreased complications.
Also, cadaveric kidneys from pediatric donors represent an important resource in face of the chronic donor organ shortage.
In this regard one can expect that the frequency of "en bloc renal transplants" will increase. The Nuclear Medicine community has to be aware of the higher frequency of urinary leaks in these patients and, depending on the surgical technique, more vascular complications are described (4,5).
Therefore we present images of one case of en bloc renal transplantation.
CASE REPORT
A 48-year-old male, with chronic renal insufficiency secundary to Berger´s disease, received two kidneys en bloc transplanted from a cadaveric 2.6 years old donor. Cold ischemia time was 22 hours. First renogram with 9 mCi of 99mTc - MAG3 was performed on a Sophycamera using a LEHR collimator at day 1 after transplantation and repeated several times thereafter depending on the clinical conditions. All images were performed in supine position.. Rejection and acute tubular necrosis (ATN) were correctly recognized during follow-up and successfully treated.
Figure 1 : SURGICAL TECHNIQUE
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Figure 2 SCINTIGRAPHIC IMAGES DAY 1 Both kidneys showed good perfusion and function. The medial kidney was rotated and presented some pelvic urinary retention.
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Figure 3 : SCINTIGRAPHIC IMAGES STUDY DAY 68 This last control study showed good perfusion to both kidneys and cortical retention due to partial recovery from a pre-renal ATN in the preceding weeks.
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| Figure 4 : ANGIOGRAPHIC CURVES DAY 68
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Figure 5 : RENOGRAPHIC CURVES DAY 68
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COMMENT
Renal scintigraphy has been widely used in renal transplant evaluation, primarely in the early detection of different types of complications like rejection, ATN, CyA nephrotoxicity (6). En bloc pediatric to adult renal transplantation, a less common technique, is associated with more urinary leaks, probably due to vascular damage at the uretero-neocystostomy site (5). Our patient showed rotation of one of the kidneys and pelvic urinary retention with no obvious dilatation. The postural mechanical stasis has already been described in one of these patients, suggesting it as a possible detrimental element (7). We recommend to keep this in mind and consider doing the renogram in the supine and upright position whenever mechanical drainage problem is suspected.
BIBLIOGRAPHY
Kelly WD, Lillehi RC, Aust JB. Kidney transplantation: experience at the University of Minnesota Hospital. Surgery 1967;62:704
Martin JE, Gonzales LL, West CD, Swatz RA, Sutorius DJ. Homotransplantation of both kidneys from an anencephalic monster to a 17 pound boy with Eagle-Barrett syndrome. Surgery 1969;66:603
Amante AJ, Kahan B. En bloc transplantation of kidneys from pediatric donors. J Urol 1996; 155:852
Meakins JL, Smith EJ, Alexander JW. En bloc transplantation of both kidneys from pediatric donors into adult patients. Surgery 1972;71:72
Satterthwaite R, Aswad S et al. Outcome of en bloc and single kidney transplantation from very young cadaveric donors. Transplantation 1997;63(10):1405-1410
Dubovsky E, Russell Ch, Erbas B. Radionuclide evaluation of renal transplants. Semin Nucl Med 1995; 25(1):49-59
Dunn E, Matthews A, Strashun S. Scintigraphic demonstration of postural induced drainage stasis in an En bloc renal allograft. Clin Nucl Med 1997;22(4):235