FEATURES OF ULTRASONIC STUDY OF NONFUNCTIONING RENAL TRANSPLANT IN

A PATIENT WITH ALLOGRAFT INTOLERANCE SYNDROME

 

Larionova S.N.¹, Vetsheva N.N.², Belavina N.I.³, Balter R.B.¹,

Manchenko O.V.³, Boryaev E.A.¹, Kanaev E.I.¹, Parabina E.V.¹, Pyshkina Yu.S.¹,

Ivanova O.V.¹, Klochkova N.N.³

 

1 - Samara State Medical University. Samara, Russia.

2 - Russian Medical Academy of Continuous Professional Education. Moscow, Russia.

3 - City Clinical Hospital No. 52. Moscow, Russia.

G

raft Intolerance Syndrome (GIS) develops in 40% of recipients after loss of allograft function and represents the main indication for transplantectomy in the late period after renal allografting. The role of ultrasound and radiology techniques in the structure of patient examination has not been fully defined, and the search for instrumental, including ultrasound, diagnostic criteria of the syndrome is in progress.

Purpose. To identify and describe the features of ultrasound, including renal allograft Doppler view in a patient with renal GIS and to compare the results with the literature data.

Materials and Methods. The clinical observation of non-functioning renal allograft intolerance syndrome in a patient with repeated renal allografting is presented; the results of complex ultrasound examination of the graft, CT-angiography, data of pathomorphological examination of the graft after its removal were analyzed. The comparison of ultrasound data of the current hospitalization with anamnestic data was carried out.

Results. A comprehensive ultrasound study revealed a unique pattern of collateral blood supply to a non-functioning renal allograft in a patient with verified renal artery occlusion and demonstrated the potential of Doppler ultrasonography to detect transcapsular retrograde perforants as specific sources of allograft blood supply in the setting of GIS development.

Discussion. The patient of our observation demonstrated a typical clinical picture for GIS: weakness, subfebrileitis, pain in the graft area, episodes of hematuria, erythropoietin-resistant anemia, and increasing inflammatory markers. GIS developed almost 10 years after renal allografting, but 9 of them the non-functioning allograft was under the full immunosuppressive therapy's protection of the second allograft. This fact confirms the opinion that its withdrawal or reduction is the main trigger of GIS onset. The pattern of de novo vascularization on the background of GIS development revealed by the complex ultrasound examination included the presence of exclusively collateral blood supply of the allograft due to the functioning of retrograde transcapsular perforants and indirectly found its confirmation in the CT-angiography findings. The pathogenetic mechanisms of angioneogenesis formation in a non-functioning renal allograft are not completely clarified, but the detection of increased perirenal and transcapsular vascularization is of great practical importance.  Such patients  demonstrate  unsatisfactory  results  with embolization of the renal artery of the allo-

 

graft and are at risk of perioperative bleeding during transplantectomy.

Conclusion. The detection of perirenal vascularization and transcapsular perforating vessels during ultrasound examination may indicate the development of renal allograft intolerance syndrome and has an important practical significance.  The presence of active vascularization of the non-functioning renal allograft should be taken into account when choosing the optimal, including surgical, treatment tactics.

To find clear instrumental differential-diagnostic criteria of GIS with other pathologic conditions in a non-functioning renal allograft, further studies are necessary.

 

Keywords: renal allograft ultrasound, kidney ultrasound, graft intolerance syndrome, transplant renal artery occlusion.

 

Corresponding author: Vetsheva N.N., e-mail: Этот e-mail адрес защищен от спам-ботов, для его просмотра у Вас должен быть включен Javascript

 

For citation: Larionova S.N., Vetsheva N.N., Belavina N.I., Balter R.B., Manchenko O.V., Boryaev E.A., Kanaev E.I., Parabina E.V., Pyshkina Yu.S., Ivanova O.V., Klochkova N.N. Features of ultrasonic study of nonfunctioning renal transplant in a patient with allograft intolerance syndrome. REJR 2024; 14(4):214-224. DOI: 10.21569/2222-7415-2024-14-4-214-224.

Received:        09.08.24                 Accepted: 10.10.24