Renal graft imaging: An update and overview

Imaging of renal graft function and pathology, including delayed graft function (DGF), often requires a multimodal approach. The existing literature describes a range of imaging modalities - radiography, computed tomography (CT), magnetic resonance imaging (MRI), ultrasonography, and nuclear medicine - some of which are more advanced and more commonly used, particularly non-ionizing modalities and nuclear medicine. These techniques are used pre- and post-transplantation in both donors and recipients to improve success of renal transplantation and monitor graft function and potential postoperative complications. Recently, significant efforts have been directed toward integrating novel artificial intelligence (AI) methodologies to enhance the diagnostic and prognostic performance of imaging, though further studies are needed to strengthen and validate these methods. Given the need to monitor renal function and complications in post-transplant patients, as well as the risks of renal biopsy and the emergence of new imaging options, reviewing the literature and synthesizing evidence from high-quality studies to provide an evidence-based summary of renal graft imaging is essential. Therefore, this narrative review sheds light on recent advancements in radiology in renal transplantation and provides an updated overview of renal graft imaging.