E2219. Transplant Page Kidney as an Unusual Cause of Renal Transplant Dysfunction: Review of Clinical Outcomes
  1. Samir Yezdani; Zucker School of Medicine
  2. Shima Tafreshi; Zucker School of Medicine
  3. Christopher Yeisley; Zucker School of Medicine
  4. Daniel Lia; Zucker School of Medicine
  5. Elliot Grodstein; Zucker School of Medicine
  6. John Pellerito; Zucker School of Medicine
With 36,527 kidney transplants performed in the US in 2018, the demand for transplant imaging and early recognition of transplant dysfunction is critical for optimal transplant management.1In conjunction with imaging, core biopsy remains the gold standard for diagnosis of allograft complications. However, renal biopsy does not come without its own additional dangers. The overall risk of complications following renal biopsy ranges from 0.6 - 13%, with hemorrhage being the predominant consideration. Hemorrhage, whether post-operative or post-biopsy, can itself cause renal dysfunction. A potential complication of hemorrhage is termed Page kidney. Our goal is to demonstrate the identification, management, and possible preventative measures for transplant Page kidney.

Materials and Methods:
All transplant patients that underwent renal sonography for concern of perinephric collection or perinephric hematoma were queried from 2013 - 2020.

A total of 436 patients underwent imaging for evaluation of perinephric collection or hematoma, 110 of whom were found to have perinephric collections, 24 (21.8%) required intervention, 13 (11.8%) by interventional radiology drainage/aspiration and 11(10%) by return to the operating room. The mean RI and maximum size of collection for patients without intervention was 0.81 and 6.13 cm, respectively, and for those with intervention was 0.89 and 10.2 cm, respectively.

The USRDS estimates a 30% 1-year mortality rate after initiation of dialysis in its 2017 report. Identification of complications and rapid treatment is especially important as the mortality rate of posttransplantation failure is estimated to be 25%. Failure to identify those complications leads to a delay in treatment, which can increase the risk of transplantation failure. In the setting of transplant Page kidney, imaging findings can be subtle and nonspecific. Increased RIs and decreased or reversed diastolic flow are important clues to the diagnosis on Doppler examination; however, changes in blood pressure may be more variable in the transplanted kidney than with native kidneys. Reversal of flow is usually associated with renal vein thrombosis and prompt evaluation for renal vein patency is required. If the renal vein is patent and reversal of flow is seen in the main renal artery and segmental branches in the post-biopsy setting, careful attention should be made to evaluate for a subcapsular hematoma. If subcapsular hematoma is identified, the patient should be promptly evaluated for IR drainage or surgical evacuation.