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The significance of a defect on DMSA scan in children with renal transplants
C Hutchinson1, M Beckett, P Kiratli
1Department of Nephrology, Great Ormond Street Hospital, London, UK. hutchc@gosh.nhs.uk
Insights
Early DMSA scans in pediatric kidney transplant patients frequently show defects, often linked to post-transplant complications like biopsy, but not pre-transplant factors. Absence of clinical issues reduced defect risk.
Area of Science:
- Pediatric Nephrology
- Transplant Surgery
- Radiology
Background:
- Pediatric renal transplant recipients often undergo early post-transplant DMSA scans.
- These scans establish a baseline for detecting future complications.
Purpose of the Study:
- To investigate associations between pre/peri-transplant factors, post-transplant complications, and DMSA scan defects in pediatric renal transplant recipients.
- To determine the significance of early DMSA scan findings in this population.
Main Methods:
- Retrospective review of case notes and DMSA scans for 45 pediatric patients scanned within 9 weeks of transplant.
- Analysis of pre-transplant factors, post-transplant complications, and DMSA scan defect presence.
Main Results:
- Forty percent of early post-transplant DMSA scans revealed defects.
- Defect presence was not linked to patient/donor age, donation type, ischemia time, or pre-existing anomalies.
- Complications like UTI, rejection, ATN, biopsy, and drug toxicity were common before scanning (87%).
- Children without clinical complications had a lower risk of defects (p=0.035).
- Biopsy was significantly associated with DMSA scan defects (p=0.0034).
Conclusions:
- Renal transplant defects are common on early DMSA scans in children.
- These defects are non-specifically associated with various post-transplant complications.
- Absence of clinical complications is a protective factor against DMSA scan defects.
Abstract:
Since December 1995, pediatric renal transplant recipients in our unit have received a DMSA scan as soon as possible post-transplant in order to provide a baseline for comparison in the event of subsequent complications. We retrospectively reviewed the case notes and DMSA scans of the 45 patients who underwent a scan within 9 wk of their transplant to see if pre or peri-transplant factors or post-transplant complications were associated with defects on scanning. Forty percentage of scans had defects. The presence of defects was not associated with potential predisposing factors such as patient or donor age, cadaveric or live donation, cold ischemia time, multiple donor vessels, the use of non-heart beating donors, the mean time to scan, the serum creatinine, or the presence of structural renal tract anomalies predisposing to UTI. However, 87% of patients had complications before the scan, including UTI, rejection, acute tubular necrosis, transplant biopsy and drug toxicity. Children with no clinical complications had a significantly reduced risk of a defect (p = 0.035), while biopsy was associated with the presence of defects (p = 0.0034). Twenty patients had one or more follow up DMSA scans: one patient developed a new focal defect. In conclusion, renal transplant defects are frequently found on DMSA scanning even early after transplantation and are non-specifically associated with many different complications.
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