Urine leak and urinomas Urinary obstruction• Relatively rare complications of • Occurs in approximately 2% of transplantation and usually transplantations ( within the first 6 constitute an early postoperative months ) problem. • At any location but is most frequent at the site of implantation of the• Due to ureteral necrosis caused ureter into the bladder. by vascular insufficiency or • More than 90% of ureteral stenosis increased urinary pressures occur within the distal third of the caused by obstruction. ureter. • Narrowing at the ureterovesical junction may be caused by scarring secondary to ischemia or rejection, by technical error during the ureteroneocystostomy, or by kinking. Retrograde pyelogram shows the area of narrowing at the site of ureteral implantation into the bladder (arrow).
Hematomas• Hematomas are common in the immediate postoperative period, but they may also develop spontaneously or as a consequence of trauma or biopsy. They are usually small and resolve spontaneously. Large hematomas can displace the transplanted kidney and produce hydronephrosis.Abscesses and infections• More than 80% of renal transplant recipients suffer at least one case of infection during the first year after transplantation.• First weeks ------ such as pneumonia, surgical wound infections, and urinary tract infections, are similar to those that typically develop in nonimmunocompromised patients who have undergone surgery.• Infections with opportunistic pathogens and cytomegalovirus often develop 1–6 months after surgery, and infections common in the general population are seen after 6 months.Lymphoceles• Lymphoceles are the most common fluid collection that causes transplant hydronephrosis. Patients with a failing allograft may develop ipsilateral lower extremity edema caused by compression of the femoral vein. In rare cases, lymphoceles may develop in the scrotum and lymphatic drainage may occur through the wound.• occurring within 1–2 months after transplantation
• Renal artery stenosis – Occurs usually in the first year after transplantation. – May be located before the anastomosis (because of atherosclerotic disease in the donor vessel), at the anastomosis (secondary to vessel perfusion injury, faulty suture technique, or reaction to suture material), or after the anastomosis (due to rejection, turbulent flow from kidney malposition, or arterial twisting, kinking, or compression). – About 80% of patients with end-stage renal disease are hypertensive, and after renal transplantation two-thirds of these groups experience a reduction in hypertension.• Infarction – Renal artery thrombosis may result from hyperacute rejection, anastomotic occlusion, arterial kinking, or intimal flap. Segmental infarcts in the renal transplant may be focal or diffuse and may occur as part of rejection or as a result of an unassociated vascular thrombosis. Vasculitis may induce small segmental infarcts. – Signs ------ absence of urinary output and often with swelling and tenderness over the graft and anuria.• Renal vein thrombosis – Renal vein thrombosis is an unusual complication of transplantation; ( less than 5% ). – C / O ----- an abrupt cessation of urinary function and swelling and tenderness over the graft. Hypovolemia, venous compression from a peritransplant fluid collection, dysfunctional anastomosis, and slow flow secondary to rejection or other allograft disease can also precipitate renal vein thrombosis.
Calculous Diseases NeoplasmsRenal transplant calculus in a 34-year-old Renal transplant adenocarcinoma. CTpatient with hematuria. (a) US image scan shows a cystic mass (arrow) arisingdemonstrates hydronephrosis with a from the renal transplant that proved toshadowing echogenic focus seen in the be renal cell carcinoma.upper middle renal pole (arrow). (b) USimage of the distal ureter shows an Prolonged immunosuppression followingechogenic focus with shadowing (arrow) renal transplantation places thea finding consistent with an obstructing transplant recipient at about 100 timescalculus. the normal risk for developing cancer.
GIT & Herniation Post-transplant LP Disorders Renal transplant herniation. CT scan Posttransplantation lymphoproliferative disease in a 25-year-old renal allograft recipientdemonstrates multiple distended small who presented with abdominal pain. (a)bowel loops around the transplanted Contrast-enhanced CT scan demonstrateskidney, findings compatible with circumferential thickening of the jejunumobstruction. Small bowel had herniated (arrows). (b)Contrast-enhanced CT scanthrough the peritoneal defect related to obtained at a lower level shows encasement of the superior mesenteric artery bythe renal graft, a diagnosis that was lymphadenopathy (arrowheads), in addition tosurgically proved. the jejunal thickening (arrow).