Renal Transplantation and Vascular Surgery
Core concepts
Understand transplant evaluation, donor selection, surgical anatomy (iliac vessel anastomosis, ureteroneocystostomy), immunosuppression, and complications by timing. Early: vascular thrombosis, urine leak, delayed graft function, hyperacute/acute rejection. Late: chronic allograft nephropathy, ureteral stricture, lymphocele, infection (CMV, BK virus). Vascular topics include renal artery stenosis (fibromuscular dysplasia vs atherosclerosis), renal artery aneurysm, and renovascular hypertension.
Traps
A rising creatinine with decreased urine output early post-transplant requires urgent ultrasound to exclude obstruction or vascular compromise. Do not give nephrotoxic drugs casually. BK nephropathy mimics rejection - check BK viral load before adjusting immunosuppression. Renal artery stenosis after transplant presents with hypertension and rising creatinine; Doppler is first-line.
Worked example
Post-transplant day 5 with oliguria and rising creatinine: obtain Doppler ultrasound. If hydronephrosis, place stent/nephrostomy; if absent flow, suspect thrombosis and act urgently.
Exam strategy
Time since transplant narrows the differential; ultrasound is the first test for graft dysfunction.