title: The role of interventional radiology in the management of kidney transplant complications.
abstract: OBJECTIVE
  To evaluate the role and the effectiveness of interventional radiology in the treatment of renal transplant complications.
  
  
  METHODS
  From 1996 to 2004 a total of 288 kidney transplants from cadavers were performed in our Institute. The kidney was always collocated in iliac fossa by creating a vascular anastomosis with the external iliac artery and vein; in all cases the ureter was implanted into the recipient bladder. During the follow-up, 34 complications were observed. Twenty-seven complications in 25 patients (20 males and 5 females; age 35-65 years) were treated by a radiologic procedure: 9 renal artery stenosis and 1 native external iliac artery stenosis (by PTA), 5 ureteral obstructions (by nephrostomy and ureteral stenting), 8 ureteral leaks (by nephrostomy, in 2 cases associated to ureteral stenting) and 4 limphoceles (by percutaneous ultrasound-guided catheter drainage).
  
  
  RESULTS
  Primary technical success was obtained in 20/27 cases (74%). Success was obtained with a second interventional procedure in 3/27 cases, 2 limphoceles and 1 ureteral fistula (secondary technical success: 85.2%), with a clinical final success in 23/27 cases (85.2%). We observed a peri-procedural complication rate of 3.7% (1 renal artery post-PTA dissection during a restenosis treatment). Four cases (1 renal arterial post-PTA dissection, 1 ureteral obstruction, 1 ureteral leak and 1 limphocele) needed a surgical correction (14.8%).
  
  
  CONCLUSIONS
  Interventional radiology is the first therapeutic approach to treat renal transplant complications. It shows good technical and clinical results and a low complication rate. Surgery had to be considered only if minimally invasive procedures are infeasible or ineffective.
authors.affiliation: Università degli Studi dell'Insubria, Varese. gcarraf@tin.it
authors.forename: Gianpaolo
authors.initials: G
authors.lastname: Carrafiello
authors.forename: Domenico
authors.initials: D
authors.lastname: Laganà
authors.forename: Monica
authors.initials: M
authors.lastname: Mangini
authors.forename: Salvatore
authors.initials: S
authors.lastname: Cuffari
authors.forename: Tamara
authors.initials: T
authors.lastname: Cafaro
authors.forename: Chiara
authors.initials: C
authors.lastname: Recaldini
authors.forename: Eugenio
authors.initials: E
authors.lastname: Genovese
authors.forename: Carlo
authors.initials: C
authors.lastname: Fugazzola
mesh_terms: D000328:Adult; D000368:Aged; D015901:Angiography, Digital Subtraction; D000800:Angioplasty, Balloon; D002102:Cadaver; D004322:Drainage; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007682:Kidney Pelvis / Q000601:surgery; D016030:Kidney Transplantation / Q000009:adverse effects; D008210:Lymphocele / Q000601:surgery; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D011183:Postoperative Complications / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery / Q000628:therapy*; D015642:Radiology, Interventional; D012078:Renal Artery Obstruction / Q000175:diagnosis / Q000601:surgery / Q000628:therapy; D015607:Stents; D013997:Time Factors; D018615:Ultrasonography, Doppler, Color; D014517:Ureteral Obstruction / Q000000981:diagnostic imaging / Q000601:surgery; D014567:Urography