Prognostic value of angiography in management of severe acute renal transplant rejection.

Angiograms of 34 kidney transplant patients with progressive decrease in renal function after multiple doses of intravenous methylprednisolone (MP) were evaluated retrospectively in regard to the prognostic value of angiography. The following parameters were included in evaluation: prolonged arterial washout time, large vessel vasculitis, presence of arteriovenous shunting, poor cortical perfusion as evidenced by non-filling of cortical vessels, poor definition of cortico-medullary junction, and a poor nephrogram. When 1 to 3 of these abnormalities existed in angiogram, 67% of living related donor transplants (LRD) recovered under continued MP-therapy. With 4-6 angiographic abnormalities the recovery rate was reduced to 30%. The overall recovery rate for LRD transplants was 44%. Cadaveric transplants (CAD) had a statistically significant poorer prognosis as evidenced by only 8% recovery rate under continued MP-therapy.