END-STAGE RENAL-TRANSPLANT FAILURE - ALLOGRAFT APPEARANCES ON CT

Introduction: Failed renal allografts often are left lit situ in patie nts who revert to chronic dialysis therapy or who undergo retransplant ation, These patients mag be investigated with computed tomography (CT ) imaging for allograft-related or other abdominopelvic disease, This study describes the appearances of failed renal transplants on CT, Met hods: A retrospective study was made of the clinical records and CT fi ndings on 25 studies in 14 patients, 5-156 months (average, 44 months) following allograft failure, CT studies were reviewed for allograft p osition, size, shape, attenuation value, calcification, cyst formation , related abdominopelvic findings and the presence of other allografts , Correlation was made with clinical findings in all patients and with pathological findings in six. Results: Global shrinkage was noted in eight failed allografts, all of which were asymptomatic, Enlargement o f two failed allografts was due to symptomatic acute infarction of the allograft in one patient and subacute haemorrhagic infarction simulat ing a tumour mass in another, CT attenuation values in individual allo grafts varied markedly due to fatty replacement, hydronephrosis, haemo rrhage or dense calcification, Both a failed longstanding and a functi oning more recently placed renal allograft were present in seven patie nts, four of whom had acute complications related to the more recently transplanted kidney, Two of six calcified allografts mere mistaken fo r opacified bowel on CT, Conclusion: A wide spectrum in size, shape an d attenuation values may be detected in failed renal allografts by CT, These organs may be the site of acute disease despite their lack of p hysiological function or may be diagnostically confusing findings in p atients with acute disease related to more recently transplanted organ s.