Interventional radiology management for kidney graft complications

The aim of the paper is to review the role and the effectiveness of interventional radiology in the management of complications after kidney transplantation. Between 1996 and 2005, 350 consecutive kidney transplantations were performed in our Hospital. A retrospective review of interventional procedures performed during the follow-up was conducted; in this period, 40 complications in 38 patients (28 males and 10 females; age 35-65 years) were treated by means of radiological procedures: 12 renal artery stenoses and 1 native external iliac artery stenosis, 12 ureteral obstructions, 8 ureteral leaks, 6 lymphoceles and 1 Graft Intolerance Syndrome (32.5% vascular complications, 50% urinary complications, 17.5% other complications). Primary technical success was obtained in 32/40 of complications (80%). Success was obtained with a second interventional procedure in 4/40 cases (2 lymphoceles, 1 ureteral fistula and 1 renal artery stenosis) with a secondary success rate of 90%. We observed a peri-procedural complication rate of 2.5% (1 renal artery post-PTA dissection during a restenosis treatment). Five cases (1 renal artery post-PTA dissection, 1 ureteral obstruction, 1 ureteral leak and 2 lymphoceles) needed surgical correction (12.5%). Interventional radiology could be considered the first therapeutic approach in the management of renal transplantation complications. It shows good technical and clinical results and a low complication rate. Surgery has to be considered only if minimally-invasive procedures are unfeasible or ineffective.