Report of the Radionuclides in Nephrourology Committee for evaluation of transplanted kidney (review of techniques)


Serval ID
Article: article from journal or magazin.
Publication sub-type
Review (review): journal as complete as possible of one specific subject, written based on exhaustive analyses from published work.
Report of the Radionuclides in Nephrourology Committee for evaluation of transplanted kidney (review of techniques)
Seminars in Nuclear Medicine
Dubovsky  E. V., Russell  C. D., Bischof-Delaloye  A., Bubeck  B., Chaiwatanarat  T., Hilson  A. J., Rutland  M., Oei  H. Y., Sfakianakis  G. N., Taylor, A., Jr. 
0001-2998 (Print)
Publication state
Issued date
Journal Article
Review --- Old month value: Apr
Comprehensive evaluation of renal transplants has been important in differential diagnosis of medical and surgical complications in the early post-transplantation period and in the long-term follow-up. If performed well, it yields excellent functional and good anatomic information about the graft that can be effectively used in the patient. That includes selection of patients for biopsy and for various drug regimens. This is true especially in patients with anuric acute tubular necrosis (ATN) and in patients with developing chronic rejection. Improving indices of renal function (effective renal plasma flow, uptake of tubular tracers) can indicate resolution of tubular injury (ATN) while there is still no improvement in plasma creatinine. In patients with chronic rejection, plasma creatinine increases only after approximately 30% of renal function is lost due to graft fibrosis. Early recognition of this condition could permit treatment and delay of retransplantation. The protocol recommended at the Copenhagen meeting includes a flow study, scintigram of the kidneys, prevoid and postvoid bladder image, injection site image (quality control), time/activity curves of the graft and bladder, and quantitative data of perfusion, function, and tracer transit. The flow study obtained during the initial transit of the bolus through the graft could be performed either with 99mTc mercaptoacetyltriglycine, or 99mTc diethylenetriaminepentaacetate (DTPA). Quantitative analysis of perfusion facilitates interpretation of the study during the early post-transplantation period. ATN, common in cadaver transplants, typically shows adequate perfusion. The function phase should include images and time/activity curves. Images alone are insufficient. Quantitative data such as clearance or other indices of function and indices of tracer transit are essential for correct interpretation of the results. Normal images and normal graft function reliably exclude clinically important complications. A single scintigram demonstrating prolonged tracer transit with decreased function cannot separate acute rejection and ATN. On serial studies, decline in function and poor perfusion are indicative of acute rejection. A normally appearing scintigram without cortical retention, but with low function, is consistent with chronic rejection. Pharmacological intervention to exclude obstruction (diuretic renogram) or hemodynamically significant renal artery stenosis (angiotensin converting enzyme challenge) should be used whenever indicated.
Angiotensin-Converting Enzyme Inhibitors/diagnostic use Diuretics/diagnostic use Fibrosis Follow-Up Studies Graft Rejection Humans Image Interpretation, Computer-Assisted Image Processing, Computer-Assisted Kidney/*radionuclide imaging Kidney Transplantation/*radionuclide imaging Kidney Tubular Necrosis, Acute/etiology Postoperative Complications/radionuclide imaging Radioisotope Renography/methods/*standards Renal Plasma Flow, Effective Technetium Tc 99m Pentetate/diagnostic use
Web of science
Create date
25/01/2008 12:21
Last modification date
20/08/2019 16:31
Usage data