Page 369 - Libro 2

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Evaluation of Kidney and Liver Transplants
M. Robert De Jong, Leslie Millar Scoutt, and Monica Fuller
OBJECTIVES
GLOSSARY
allograft any tissue transplanted from one human to another human
arteriovenous fistula a connection between an artery and a vein, usually posttraumatic in origin
immunosuppression drugs drugs used to inhibit the body’s formation of antibodies to the allograft
orthotopic transplant a transplant that is placed in the same anatomic location as the native organ; a whole liver transplant is an orthotopic
Ultrasound evaluation of transplanted organs has
transplant; renal transplants are not orthotopic in location
pseudoaneurysm develops secondary to a tear in the arterial wall, allowing extravasa- tion of blood from the arterial lumen, which is contained by a compacted rim of surrounding soft tissue
transplant rejection the failure of a transplant occurring secondary to the formation of antidonor antibodies by the recipient; it can lead to loss of the transplant
KIDNEY TRANSPLANTATION
The first successful kidney transplant was performed in 1954 at the Peter Bent Brigham Hospital in Boston, Massachusetts between identical twin brothers, which eliminated the potential for any adverse immune re- action.1,2 However, kidney transplants continued to be very limited due to incompatibility issues until the early 1960s, when significant advances in tissue typing allowed for better matching of donor and re- cipients occurred. In addition, immunosuppression therapy was introduced in 1961, which dramatically improved graft survival, as these drugs helped the re- cipient accept the foreign tissue in the allograft. With immunosuppression therapy, transplantation of a ca- daveric donor allograft became a realistic possibility and, in 1962, the first cadaveric kidney transplant was performed, again at the Peter Bent Brigham Hos- pital. In 1983, cyclosporine, a highly effective and
Describe the types of transplant procedures and vascular anastomoses
Define the essential components of transplant ultrasound examinations
Define the vascular complications associated with transplants
KEY TERMS
arteriovenous fistula | liver transplant | pseudoaneurysm | rejection | renal transplant | vascular stenosis | vascular thrombosis
become an established and
component of posttransplant
Modern advances in surgical immunosuppression regimens
creased long-term survival of
transplant recipients. Renal and hepatic transplan- tation are the preferred treatment for patients with renal and hepatic failure, respectively. Pancreatic, small bowel, lung, and cardiac transplants are also increasingly performed. In most series, vas- cular complications are the second most common cause of graft loss, and ultrasound (US) is consid- ered the initial screening modality of choice for the evaluation of a suspected vascular complica- tion in a renal or hepatic transplant recipient. This chapter will review the ultrasound techniques and criteria for the US examination of kidney and liver transplants.
important routine patient follow-up. techniques and in have resulted in in- both allografts and
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