Invaluable Role of Nuclear Renogram in Immediate Post Renal Transplant Complication Assessment

Nuclear Renogram can play an invaluable role in assessment of post renal transplant complication. Early recognition of renal functions loss after renal transplant can allow early management of high probability of salvaging the renal function. Subsequently an urgent USG KUB & doppler of transplant kidney was performed which revealed absent perfusion in upper half of transplant with finding suggestive of complete thrombosis of artery supplying the superior polar region corroborating with the renogram finding. Patient developed increase in abdominal girth, subsequent decrease in urine output. Patient was urgently re-explored, there was discolouration of upper half of transplant kidney with no pulsation in the artery supplying superior pole, re-anastomosis was performed. Good pulsations were noted post re-anastomosis and the upper half of kidney showed good colour after releasing the clamp. The post-operative urine output was 100 ml/hr. Approximately 24 hours post reanastomosis, patient underwent USG KUB & doppler of transplant kidney which revealed prompt preserved perfusion in upper pole of transplant, the finding suggestive of significant improvement in the arterial supply of the superior polar region. The urine output on the third day post re-anastomosis improved to 800 1000 ml/hr. We conclude that early recognition of renal functional loss post renal transplant allows early management and high probability of salvaging the renal function. Fig. 1 : Eight hours post Transplant 99mTcMAG3 renogram revealed small transplant kidney in the right iliac fossa. The upper half of kidney was not visualised and only inferior half of transplant was visualised with preserved perfusion, preserved parenchymal function and non-obstructed drainage pattern. Discussion Nuclear medicine scanning and flow studies remain the primary means for evaluating vascular supply to the 2 transplant after surgery. The main advantage of nuclear medicine scans is t h a t t h e y d e m o n s t r a t e t h e 2 pathophysiology involved. Mark T u l c h i n s k y a s s e s s e d 9 9 m T c mercaptoacetyltriglycine (MAG3) for determination of renal transplant prognosis for recovery in patients with 4 early postoperative dysfunction. The postulate tested was that good tracer extraction may imply high likelihood of recovery, while poor extraction may confer 4 a poor prognosis. M A G 3 s c a n i s a n a c c u r a t e prognosticator in patients with early po s t ope ra t i v e r ena l t r ansp l an t dysfunction. One of the most critical clinical questions in patients with dysfunctioning renal transplant during the early postoperative period is a likelihood of functional recovery. This is important because a patient who has no hope of transplant recovery could potentially benefit from early termination of immunosuppression and transplant removal. For example, early termination of immunosuppression should reduce the 5 likelihood of infections. There is evidence in patients with native kidneys who develop acute renal failure, which suggests that MAG3 can 6 predict recovery. Importantly, it takes only a few minutes after initiation of renal scintigraphy to obtain this critical information, allowing a prompt decision 7 regarding further patient management. Bombay Hospital Journal, Vol. 57, No. 3, 2015 345 The renogram curve also appeared useful 7 in evaluating prognosis. An important limitation to this investigation is that patients with absent flow and no parenchymal uptake (TISS 5 and 6) were not referred for angiography, probably because of the belief that renal transplant loss is inevitable regardless of 7 any intervention. However, recent evidence indicates that transplant function in those patients can be saved by 8 prompt restoration of blood flow. In the today's era where there is scarcity of donor organs, early recognition of deterioration of renal perfusion/ function, allows early management of complication, thereby aid in prompt measures for salvaging the renal graft function.