Evaluation of Renal Homotransplantation by Selective Angiography

Management of the patient after renal homotransplantation is often complicated and frequently requires answers to problems not previously encountered. Oliguria is the most common diagnostic question in the early postoperative period. In cadaver renal transplants oliguria may be the result of acute renal failure secondary to ischemia (1), vascular thrombosis, ureteral perforation and slough, or the rejection phenomenon. The ideal management of each of these entities requires early and accurate diagnosis. In an effort to distinguish between these complications, angiography was performed on 20 patients who received renal homotransplantations from living or from cadaver donors at the Cleveland Clinic Hospital, Cleveland, Ohio, since August 1963. Angiograms were obtained primarily to evaluate persistent anuria or oliguria in cadaver transplants, or oliguria after initial diuresis in live donor transplants. Materials and Methods Angiograms were obtained of 20 renal homografts, 15 of which were kidneys from cadaver donors and 5 from live donors. The iliac artery on the side of the homograft was selectively catheterized with a red Ödman-Ledin catheter utilizing the Seldinger technic (2). Selective studies were performed in 17 of the 20 patients and have provided more information than is gained from common iliac artery and aortic injections. Nine milliliters of 50 per cent sodium diatrizoate was injected by hand. Films were exposed when 6 ml had been injected (arterial phase) and also two seconds after the end of the injection (nephrogram phase). In addition, in recent studies cineradiography has been employed. When persistent arterial opacification was noted on delayed films the corresponding renal vein was also selectively catheterized and studied. Results In this series 9 angiographic studies were normal, 3 revealed renal artery thrombosis, 1 showed renal vein thrombosis, and 7 disclosed evidence of the rejection phenomenon. Of the 9 patients with normal angiograms, 5 have viable transplants to date (range, eighty to four hundred thirty days) with essentially normal renal function. Normal Homograft: Angiograms of the normally functioning homografts were considerably different in appearance from the pretransplantation angiogram of the kidney in the donor (Fig. 1). Edema of the homograft was almost invariably present, causing a stretched appearance of the vascular tree. In addition, the homograft often rested obliquely in the pelvis. The criteria of a selective angiogram of a normal homograft are as follows: 1. Arterial phase a. Complete visualization of the arterial tree to at least the arcuate arteries b. Gradual tapering of the lumen of the interlobar and arcuate arteries c. Normal arborization of peripheral vascular distribution (Fig. 2, A).