Pediatric Renal Transplant Imaging

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

Outline

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

Objectives

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