RadteraUltrasound Renal Transplant (with Doppler)
USNo contrastAbdomen & Pelvis
Indications
- Post-transplant baseline / surveillance
- Rising creatinine / graft dysfunction
- Suspected rejection, ATN, or obstruction
- Suspected perinephric collection (hematoma, urinoma, lymphocele, abscess)
- Suspected vascular complication (RAS, thrombosis, AV fistula)
Patient prep
- None; moderately full bladder helpful
- Supine; graft typically in iliac fossa (superficial)
Contrast
None / non-contrast
Technique
- Linear or curvilinear transducer depending on depth (graft is superficial)
- Grayscale of graft in long and transverse
- Color Doppler of main and intrarenal vessels; spectral waveforms with resistive index (RI)
- Evaluate perinephric space and bladder/ureter
Series / Sequences
| # | Series / Sequence | Plane | Notes |
|---|---|---|---|
| 1 | Transplant kidney long axis | Long axis | Measure length; echotexture, corticomedullary differentiation |
| 2 | Transplant kidney transverse | Transverse | Hydronephrosis |
| 3 | Collecting system | As needed | Hydronephrosis/obstruction |
| 4 | Main renal artery and vein (anastomosis) | Spectral + color | PSV; assess for stenosis/thrombosis |
| 5 | Intrarenal arteries (upper/mid/lower pole) | Spectral | Resistive index (normal ~0.6-0.7; RI >0.8 abnormal/nonspecific) |
| 6 | Perinephric space | As needed | Collections - hematoma, urinoma, lymphocele, abscess |
| 7 | Bladder | As needed | Distension, ureteral jets |
Key points
- Doppler is integral: record main vessel waveforms and intrarenal resistive indices at upper, mid, and lower poles
- Elevated RI (>0.8) is nonspecific (rejection, ATN, obstruction, compression); correlate clinically
- Assess for hydronephrosis and peritransplant collections
- Evaluate transplant renal artery for stenosis (focal high PSV, tardus-parvus distally) and rule out venous thrombosis
References
• AIUM Practice Parameter for the Performance of Native and Transplanted Kidney Ultrasound Examinations
• ACR Appropriateness Criteria: Renal Transplant Dysfunction
• Radiopaedia: Renal transplant ultrasound link
• ACR Appropriateness Criteria: Renal Transplant Dysfunction
• Radiopaedia: Renal transplant ultrasound link
Source: Researched — verify against your institution
Reference template — verify and adapt to your scanner, vendor and institution before clinical use. Not a substitute for clinical judgment.