title: Routine transplant Doppler ultrasonography following pediatric kidney transplant.
abstract: The utility and cost-effectiveness of routine transplant renal DU as a screening test in the immediate postoperative period following pediatric renal transplantation has not been systematically evaluated. Our center's transplant protocol includes a routine DU on postoperative day 3, unless an earlier DU was obtained for a specific indication. We retrospectively evaluated 113 consecutive pediatric renal transplant recipients. Indication for DU (routine vs. non-routine), timing, results, and graft outcome data were collected. We determined whether the DU result affected patient management. Eighty routine DU examinations were evaluated. Thirty (37.5%) of the 80 routine DUs had abnormalities. Most abnormalities were minor and did not require intervention. One patient with a dysfunctional bladder had mild hydronephrosis; this led to a decision to increase the frequency of bladder catheterization. This was the only intervention based upon the routine DUs. Twenty percent of routine DUs revealed abnormalities that led to a follow-up study, but none of these studies led to an intervention. The incremental cost of each DU exceeded $1080 and the incremental cost-effectiveness ratio for a documented change in management exceeded $86, 400. Our results suggest that routine post-transplant DU is not cost-effective in pediatric renal allograft recipients.
authors.affiliation: Children's Healthcare of Atlanta, Atlanta, GA, USA.
authors.forename: Raed
authors.initials: R
authors.lastname: Bou Matar
authors.forename: Barry
authors.initials: B
authors.lastname: Warshaw
authors.forename: Leonard
authors.initials: L
authors.lastname: Hymes
authors.forename: Larry A
authors.initials: LA
authors.lastname: Greenbaum
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D005260:Female; D006084:Graft Rejection; D017048:Health Care Costs; D006801:Humans; D007223:Infant; D007668:Kidney / Q000002:abnormalities / Q000000981:diagnostic imaging; D016030:Kidney Transplantation / Q000191:economics / Q000379:methods*; D008297:Male; D010372:Pediatrics / Q000379:methods*; D011184:Postoperative Period; D012189:Retrospective Studies; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler / Q000191:economics / Q000379:methods*