Renal transplantation in nm

Anatomy of a kidney transplant

• The transplantation of kidneys from living and cadaveric
donors is a well-established organ transplantation procedure
both surgically and medically.
• Transplants are placed in the anterior iliac fossa with vascular
anastomosis to the hypogastric artery and the external iliac
vein, and with ureteral implantation into the bladder.
• Radionuclide imaging using Tc-99m DTPA or Tc-99m MAG3 is a
useful tool in evaluating the medical and surgical complications
of renal transplantation
 Patient preparation
• The patient should be well hydrated.
• Patient to void before imaging.
• No special preparation is required
 Radiopharmaceuticals
• Technectium-99m-MAG3 and DTPA are used to assess
transplant function, but MAG3 is preferred in patients with
impaired renal function
 positioning
• Patient is supine
• Patients head rested on a pillow
• Patient is symmetrically positioned with arms along side the
body
• Anterior images are obtained over the iliac fossa containing the
transplant kidney
images
 After the renal transplant
• A normal scan immediately after transplant excludes mechanical
complications. Serial scans during the first 1–3 weeks after
transplantation can be used to monitor recovery from post-
transplantation acute tubular necrosis (ATN) and may detect early
rejection 24–48 hours before biochemical abnormalities occur.
• A baseline renal imaging is done to;
- To evaluate arterial flow and function
- To help diagnose rejection and acute tubular necrosis
- To detect urinary leak, infarct or outflow obstruction
 Complications of Renal transplant
• Acute tubular necrosis
• Rejection and antirejection medication toxicity
• Surgical mishaps
• Rejection presents as diminished flow with delayed uptake and
excretion
• ATN presents with good flow and delayed uptake and
excretion, but severe ATN also can present with diminished
flow.
• Functional imaging methods based on nuclear medicine, such
as the dynamic renal study which use glomerular filtration
agents and tubular secretion agents, are useful and routinely
used tools for evaluation of renal transplants.
• Glomerular agents (99mTc-DTPA) are considered to be ideal
ones, since glomerular filtration is defined as the main reflex of
renal function
 references
• www.intechopen.com/books/current-issues-and-future-
direction-in-kidney-transplantation/imaging
• Mettler.G (2012)Essentials of Nuclear Medicine Imaging. 6th Ed.
Elsevier
• www.interactive.snm.org/docs/cg_ch03