Use of Intraoperative Duplex Ultrasound and Resistance Index Reduces Complications in Living Renal Donor Transplantation

Abstract

Background: The treatment of choice in end-stage renal disease is transplantation. Hemodynamic disturbances can evoke graft loss, while early ultrasound identification of vascular problems improves outcome. The aim of this study was to identify differences in post-op complications with and without systematic, intra-operative Doppler ultrasound use. Methods: The primary outcome was the post-operative rate of complications and the secondary aim was to find a predictive resistance index cut-off value, which would show where surgical reintervention was necessary. Over a 10-year period, 108 renal transplants were performed from living donors at our institution. In group 1 (n=67), intra-operative duplex ultrasound and intra-parenchymatous resistance index measurements assessed patients, while in group 2 (n=41), no ultrasound was performed. Results: There were no inter-group differences in the overall post-op complication rate or in benefit to graft or patient survival with Doppler use. However, significantly more vascular complications (10% vs. 0%, p=0.02) and more acute rejections (37% vs. 10%) occurred in group 2 than in group 1. It was thus propose an intra-operative cut-off value of the resistance index of 0.5 to justify immediate surgical revision. Conclusions: This is the first report demonstrating benefits of systematic intra-operative Doppler ultrasound on post-operative complications in renal transplantation from living donors. Our results support surgical revision with a resistance index <0.5.