Arterial Occlusion
Female, 20 year old on hemodialysis came to the hospital to perform living related donor kidney transplant in the right iliac fossa. At 24 h post - operative evolves anuric. Renal scintigraphy with 99mTc-MAG-3 depicted excellent contrast in the aorta and iliac vessels, but abscense of perfusion in the parechyma (black arrows around the kidney mostly photopenic) at 3 min. This finding is consistent with arterial occlusion. At 30 min (right hand side), both native kidneys are visualized, pointed by yellow arrows and explain the bladder activity. The photopenic trasplanted kidney image presents no chenges, black arrow.
Kidney renography is an excelent procedure to assess the arterial and venous vessel patency, though the pattern of absence of flow in the graft and hypoactive organ cannot differentiate these conditions from each other (1).
In a series of 10 patients, Ramos et al., found that patients with bank
grafts, had acceptable renal function, except one of then who was treated
with transplantectomy due to a renal venous thrombosis, as the case presented
herein. This would be a bad prognosis sign.
References:
1 Etchebere, Elba, Ramos Celso Dario y Camargo, Edwaldo. Trasplante Renal.p: 425-433 en: Medicina Nuclear Aplicaciones Clínicas. Eds: I. Carrio - P. González. Editorial Masson, Barcelona España, 2003.
2 Ramos E, Alonso JC, Durán C, Gómez I, Martínez S, Almoguera I, Bittiini A, Domínguez P, Pérez Vázquez JM. Graft viability of patients with renal transplantation from non heart beating donors. Rev Esp Med Nucl. 2005 Jan-Feb;24(1):32-7.