Ultrasonographic Features and Complications of Renal Grafts as Seen at Kenyatta National Hospital

Abstract

Renal transplantation is considered a treatment of choice for end-stage renal disease (ESRD) since the 1960s. It is cost effective and provides better long-term survival and better quality of life in comparison to hemodialysis or peritoneal dialysis. Two-dimensional ultrasound (U/S) scan was introduced in the evaluation of renal transplants in the early 1970s, while the application of Doppler techniques in routine practice was established in the following years. Ultrasound is a relatively cheap, noninvasive, and non nephrotoxic imaging modality, which can be applied for diagnostic and monitoring purposes in the post transplant period, thus establishing a baseline for follow-up scanning. Its role in the evaluation of early graft complications is of great significance as besides detecting complications it is also utilized in an interventional procedure like fluid aspiration. Objective To evaluate the Ultrasonographic findings and complications of the renal grafts seen at Kenyatta National Hospital. Study design Retrospective descriptive Study setting The study was carried out in the Renal unit, Kenyatta National Hospital. Study population The study included all the adult patients who underwent the renal transplant at KNH after satisfying the inclusion criteria. Study period Study period was two (2) years (March 2014 to March 2016) Methodology A data collection sheet was used to manually record the demographic data, type of wide range of complications seen post renal transplant. These records were available in the patient’s files of those who underwent the renal transplant in Kenyatta National Hospital from the period of March 2014 to March 2016. The data was entered into an MS Excel database and analyzed using a 20th version of Statistical Package for Social Scientists (SPSS). Patient’s longevity and graft survival were not evaluated as, this was beyond the scope of this study. xiii Results A total of 46 subjects were enrolled into the study. The Mean age of the study subjects was 41.2 ± 1.8 years (SD = 12.1years). Majority of the study participants were male 34(73.9%) and 12 (26.1%) were female. Twenty-three(eighteen males and five females) out of the forty-six patients developed post transplant complications taking overall complication rate to 50%.The most common complication seen was the peritransplant fluid collection(72.5%) followed by parenchymal(10.3%), vascular(10.3%) and collecting system(6.9%) complications. Among the peritransplant fluid collection hematoma (44.8%) was the commonest finding. Conclusion The diagnostic yield of ultrasound in detecting the renal graft complications are high and with the absence of nephrotoxicity and radiation, ultrasound is often the first and only imaging modality used to monitor grafts during routine follow-up and assess for mild to serious complications. With many complications occurring at predictable period post transplant, awareness of these pathologies and their imaging features are vital to ensure there are early detection and timely intervention to prolong the graft survival.