Renal transplant evaluation.

Radionuclide scintigraphy of the renal transplant has assumed an important role in disclosing the complications that beset this life-prolonging procedure. Renal ischemia, whether caused by mechanical obstruction of the blood vessels or ureter or immunological rejection, can be detected by qualitative and quantitative perfusion studies using 99mTc-complexes such as pertechnetate, glucoheptonate and DTPA. Similarly, parenchymal agents such as radiohippurate and 99mTc-DTPA can be quantitated for uptake and their drainage patterns monitored to reveal possible underlying obstructive uropathy and urine extravasation. The literature is replete with mathematical strategems for quantitating perfusion and parenchymal transit of the tracers, but none are truly specific enough to be diagnostic of a given cause of renal ischemia. Serial quantitative radionuclide studies should be obtained during the first 2-3 wk after transplantation with the view of noting an improvement or deterioration of the quantitation parameters as a guage of progress. A deterioration may anticipate biochemical manifestations by 24-48 hr, but it is not specific and must be interpreted in light of the clinical circumstances or necessitate invasive procedures for a definitive diagnosis.