Ultrasound of renal transplantation

The most effective primary treatment of chronic renal failure is renal transplantation. A significant improvement in lifestyle and family life in conjunction with it being an extremely cost-effective procedure has resulted in an intense monitoring and imaging programme to help ensure a successful outcome. Ultrasound, both grey-scale and colour-flow Doppler, are useful monitoring techniques when interpreted in the clinical context, and in the delineation of peri-transplant collections, some of which can be drained under ultrasound guidance. After the early post-operative period it can also be utilized in the diagnosis of chronic vascular complications including transplant artery stenosis and arteriovenous fistula, although it is of limited use in the diagnosis of chronic rejection. This article will discuss the role of ultrasound in all its guises and how its efficacy in both the early transplant period in the monitoring of graft dysfunction and in the detection of the more chronic conditions including transplant artery stenosis and arteriovenous fistulae. A more limited role for ultrasound also exists in the long-term follow-up of patients and to aid the detection of complications including susceptibility to malignancy.