Risks versus benefits of contrast medium exposure in renal allograft recipients
Peters, C.; Delmonico, F.L.; Cosimi, A.B.; Rubin, R.H.; Tolkoff-Rubin, N.; Baker, G.; Russell, P.S.
Surgery Gynecology and Obstetrics 156(4): 467-472
1983
ISSN/ISBN: 0039-6087 PMID: 6340225 Document Number: 207191
Of 211 consecutive renal allograft recipients, 93 underwent i.v. pyelographic or arteriographic studies during the 1st 2 mo. after transplantation. Careful evaluation of these patients was undertaken to assess the possible risks of contrast exposure to allograft function. During this early post-transplant period, 78 of 93 contrast-exposed patients, 84%, and 86 of 118 noncontrast-exposed patients, 73%, had 1 or more renal failure episodes. The over-all risk of renal failure episodes, although apparently higher in the contrast-exposed patients, was not significantly different from the noncontrast-exposed patients. Among the 78 patients with deterioration of allograft function sometime after contrast exposure, a rise in the creatinine value developed in 45 patients within 12 days of the study. Separate analysis of this subgroup was undertaken, since most adverse effects resulting from the contrast medium should appear within this time period. Fourteen of these patients, 31%, subsequently progressed to allograft failure or chronic rejection. This was comparable to the incidence of allograft failure or chronic rejection, 28%, which was observed in the 119 patients in whom a renal failure episode occurred either without previous contrast exposure more than 12 days after a constrast study. The lack of significant toxicity to allograft function was further confirmed in patients studied more than 2 mo. after transplantation. No episodes of renal failure were noted in 21 patients undergoing contrast studies without evidence of rejection at the time, and 75% of the allografts studied during a rejection episode returned to normal function. Biopsies of allografts obtained as part of the diagnostic evaluation of the renal dysfunction in these patients also failed to reveal any of the typical histopathologic criteria of contrast toxicity. Evidently the risk of having either more frequent or more severe renal failure episodes develop because of i.v. pyelographic or arteriographic studies in renal allograft recipients is small. Significant roentgenologic findings were obtained in only 4% of the contrast studies in this series. Apparently routine evaluation of allograft status can alternatively and, perhaps, more safely be accomplished by nuclear isotopic imaging or ultrasound. The performance of excretory urography or renal arteriographic studies should be limited to those recipients requiring documentation of specifically suspected lesions, such as ureteral leaks or arterial stenosis.