Doppler Ultrasound Evaluation of Renal Allograft: Experience at BSMMU, Bangladesh

Background: Renal transplantation is the treatment of choice for patients with end-stage renal disease (ESRD). Doppler ultrasound is the primary imaging modality for evaluating renal allografts, providing critical insights into graft morphology, vascular integrity, and complications.

Objective: This study aims to assess the role of Doppler ultrasound in evaluating renal allografts at Bangabandhu Sheikh Mujib Medical University (BSMMU), Bangladesh, with a focus on graft function, perfusion, and post-transplant complications.

Methods: A purposive sampling technique was employed to select 43 renal transplant recipients at BSMMU. B-mode and Doppler ultrasound were utilized to assess graft size, echogenicity, cortico-medullary differentiation, collecting system, and vascular structures. Parameters such as peak systolic velocity (PSV), resistive index (RI), and pulsatility index (PI) were analyzed using MS Office tools.

Results: Normal graft function was associated with a PSV range of 80–118 cm/sec and an RI <0.7. Complications were categorized based on onset time, including acute tubular necrosis, rejection, thrombosis, and stenosis. Increased cortical echogenicity, reduced renal sinus echogenicity, and high-resistance waveforms were indicative of graft rejection. Significant renal artery stenosis was characterized by PSV >250 cm/sec and a systolic velocity ratio >3.

Conclusion: Doppler ultrasound is a non- invasive, first-line diagnostic tool for assessing renal allografts and detecting major post-transplant complications. However, it has limitations in distinguishing between acute rejection, tubular necrosis, and immunosuppressive toxicity. Supplementary imaging modalities like CT, MRI, or angiography may be required for inconclusive cases.

Keywords: Doppler ultrasound, Graft rejection, Renal allograft, Resistive index, Peak systolic velocity, Transplantation.