The angiographic signs of rejection in cadaver kidney transplants

Seven cadaver kidney transplants of a series of eighteen cadaver grafts, in addition to one from a living donor, were examined by angiography with the view to study the angiographic features of rejection. In all the eight cases, angiography was performed to help to clarify a complicated and dangerous clinical condition, the specific management of which depended on the exact determination of its causes. The angiographic appearance of a normal cadaver transplant was found not to differ from that of a normal kidney. The signs of rejection of slight degree were seen to be prolonged arterial phase suggesting delayed blood flow; stretching of the arteries of the first and second degree as a manifestation of oedema, and non-visualisation of the small arteries: the arcuate arteries are usually visible. The nephrographic phase, the outline of the kidney and the cortex appear normal. In rejection of severe degree, the main renal artery is involved, presenting varying degrees of narrowing. The arterial phase is short. The arteries of first degree may be faintly visible and narrowed: the other vessels (second degree, arcuate and small arteries) are not visualised. There is no nephrographic phase shown: the outline of the kidney and the cortex are not seen. In addition to the clear demonstration of the iliac artery and the anastomosis, angiography of cadaver kidney transplants represents a very important addition to the evaluation of the causes of rejection, which are not shown by isotope studies (renogram or renal scan). The method was found to be of great help in deciding the clinical management of seriously ill patients.