Renal transplantation is one, if not the most, common transplant procedures undertaken worldwide. Consequently, purposeful and incidental imaging of renal transplants and renal transplant-related complications are increasingly common. These include acute renal transplant rejection and chronic renal transplant rejection. Both donors and recipients undergo a preoperative workup.
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Radiographic features
Most renal transplants are sited in the extraperitoneal right iliac fossa. For a variety of surgical reasons (including vessel suitability or previous failed renal transplants), they may occur in the left iliac fossa or elsewhere.
Plain radiograph
- renal transplant not often visualized directly as obscured by other soft tissues of the pelvis but may be visible if calcified (i.e. failed)
- surgical paraphernalia such as clips and ureteric stents may be visible
- complications related to underlying disease, or the renal transplant and its associated anti-rejection medications (e.g. osteonecrosis)
Ultrasound
Renal transplant ultrasound is commonly utilized to evaluate for complications postoperatively. Read the separate article on this for US features 2.
Renal transplant scintigraphy
Transplant renal scintigraphy is mostly used for the evaluation of urological and vascular complications (renal transplant complications), and postoperative fluid collections (renal transplant fluid collections) 3.
Practical points
The preoperative workup should include a chest and abdominal x-ray, an abdominal ultrasound, an echocardiogram and coronary stress tests. However, in most patients, an abdominal CT is also useful to evaluate arterial calcifications and caliber (especially of the right external iliac artery) 4.
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