Colour-coded duplex sonography in the diagnostic assessment of vascular complications after kidney transplantation in children.

BACKGROUND: Vascular complications are a major cause of dysfunction or transplant loss in children. Arterial or venous occlusion, transplant renal artery stenosis (TRAS) and some arteriovenous (AV) fistula require rapid detection and prompt intervention. The present study was performed to determine the accuracy of colour Doppler sonography (CDS) in the early and late phase after renal transplantation and to correlate the results with angiographic and intraoperative findings. OBJECTIVE: CDS is the preferred imaging modality with a high diagnostic accuracy for follow-up of renal transplantation in children. The indication for angiography should be established on the basis of the CDS diagnosis. MATERIALS AND METHODS: In 87 children (mean age 10.9 years, range 2-17), 423 CDS examinations were performed after renal transplantation. Angiography was performed in 17 cases; surgery was necessary in 16 patients. RESULTS: CDS correctly identified 8/8 arterial or venous occlusions and 7/7 TRAS. The only false positive diagnosis of TRAS was due to misinterpretation of an iliac artery stenosis. Six AV fistulae were diagnosed by CDS. The overall positive predictive value of CDS was 94 % in this study. CONCLUSION: CDS is a noninvasive, non-radiation producing imaging modality with a high diagnostic accuracy. It is the method of choice in the assessment of vascular complications after renal transplantation in children.