Pediatric Renal Transplant Imaging

A review of the imaging appearances of pediatric renal transplants and their common complications.

Course ID: Q00396 Category:
Modalities: , , , ,


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Targeted CE per ARRT’s Discipline, Category, and Subcategory classification for enrollments starting after May 25, 2023:
[Note: Discipline-specific Targeted CE credits may be less than the total Category A credits approved for this course.]

Computed Tomography: 2.75
Procedures: 2.75
Abdomen and Pelvis: 2.75

Magnetic Resonance Imaging: 3.75
Patient Care: 1.00
Patient Interactions and Management: 1.00
Procedures: 2.75
Body: 2.75

Nuclear Medicine Technology: 3.75
Patient Care: 1.00
Patient Interactions and Management: 1.00
Procedures: 2.75
Gastrointestinal and Genitourinary Procedures: 2.75

Registered Radiologist Assistant: 3.75
Procedures: 3.75
Abdominal Section: 3.75

Sonography: 3.75
Patient Care: 1.00
Patient Interactions and Management: 1.00
Procedures: 2.75
Abdomen: 2.75

Vascular-Interventional Radiography: 3.00
Procedures: 3.00
Vascular Diagnostic Procedures: 1.00
Vascular Interventional Procedures: 1.00
Nonvascular Procedures: 1.00

Vascular Sonography: 3.75
Patient Care: 1.00
Patient Interactions and Management: 1.00
Procedures: 2.75
Abdominal/Pelvic Vasculature: 2.75


  1. Introduction
  2. Surgical Technique
  3. Postoperative and Surveillance Imaging
  4. The Normal Renal Allograft
  5. Posttransplant Complications
  6. Perinephric Fluid Collections
    1. Hematoma and Seroma
    2. Graft Infection and Abscess
    3. Lymphocele
  7. Vascular Complications
    1. Renal Artery Thrombosis and Renal Infarction
    2. Renal Vein Thrombosis
    3. Renal Artery Stenosis
    4. Arteriovenous Fistulas and Pseudoaneurysms
  8. Urologic Complications
    1. Urine Leak and Urinoma
    2. Urinary Tract Obstruction
    3. Vesicoureteral Reflux
  9. Abnormalities of Graft Function
    1. Acute Tubular Necrosis
    2. Rejection
      1. Hyperacute Rejection
      2. Acute Rejection
      3. Chronic Rejection
    3. Toxic Effects of Calcineurin Inhibitors
    4. Recurrent Disease
  10. Mass Lesions
    1. Posttransplant Lymphoproliferative Disease
    2. Inflammatory Myofibroblastic Tumor
  11. Conclusions


Upon completion of this course, students will:

  1. understand the complementary roles of US and nuclear medicine in characterizing post-transplant complications
  2. identify the perinephric fluid collections associated with renal transplantation
  3. know the role renal scintigraphy plays in elucidating common complications including urine leak and urinary tract obstruction
  4. identify the predominant cause of end-stage renal disease during infancy and childhood
  5. be familiar with the number of pediatric patients undergoing renal transplantation on an annual basis
  6. know who is credited with the construction of the first renal dialyzer
  7. be familiar with the year the first dialyzer was constructed
  8. know the mainstay for imaging renal transplants in children
  9. identify the most commonly used radiopharmaceutical for renal perfusion
  10. be familiar with deterrents for using CT on pediatric renal transplantation patients
  11. be familiar with the normal thickness of the walls on the renal pelvis when performing US
  12. be familiar with the normal range of the US resistive index in the arterial system of the kidney
  13. be familiar with the normal time-to-peak activity when performing renal scintigraphy
  14. identify the date of the first successful renal transplantation
  15. be familiar with the physician who is credited with the first renal transplantation
  16. identify the most common immunosuppressive medications for renal transplantation
  17. be familiar with the discovery and role of cyclosporine
  18. be familiar with late phase renal transplant complications
  19. be familiar with the renal transplant complications associated with rejection
  20. be familiar with the characteristics of the Page kidney
  21. identify the characteristics of a pseudorejection on renal scintigraphy
  22. identify the most common cause of allograft infection in renal transplantation
  23. be familiar with the characteristics of 99mTc-DMSA
  24. identify the causes of perinephric abscesses in renal transplantation
  25. be familiar with the ultrasound findings associated with pyonephrosis
  26. be familiar with the nuclear medicine examination used to distinguish lymphoceles from urinomas
  27. be familiar with the hormones produced by the kidneys
  28. identify the basic functional unit of the kidney
  29. be familiar with the most common cause of 1st year allograft loss in children
  30. identify the procedures that may be used when renal artery thrombosis occurs during renal transplantation
  31. be familiar with the sensitivity of ACE-inhibited renal scintigraphy for diagnosing renal artery stenosis after renal transplantation
  32. understand the criteria for treating pseudoaneurysms during renal transplantation
  33. understand the characteristics of 99mTc-DTPA
  34. identify the renal radiopharmaceuticals used for morphological imaging
  35. be familiar with the distribution of 99mTc-DMSA
  36. be familiar with the complications of vesicoureteral reflux during renal transplantation
  37. be familiar with the characteristics of a urine leak during 99mTc-mertiatide renal scintigraphy
  38. identify which medical imaging tests are invaluable in the determination of post-transplant urinary tract infection
  39. be familiar with the causes of delayed graft function during renal transplantation
  40. be familiar with the basis for characterizing renal allograft rejection
  41. identify immunosuppressant agents that act as calcineurin inhibitors
  42. understand the patient preparation for renal scintigraphy
  43. be familiar with the areas of the body affected by post-transplant lymphoproliferative disease
  44. identify the procedure used to provide a definitive diagnosis of an inflammatory myofibroblastic tumor
  45. be familiar with the renal scintigraphy positioning of a patient that has had renal transplantation