Routine transplant Doppler ultrasonography following pediatric kidney transplant

Bou Matar R, Warshaw B, Hymes L, Greenbaum LA. Routine transplant Doppler ultrasonography following pediatric kidney transplant. Abstract:  The utility and cost‐effectiveness of routine transplant renal DU as a screening test in the immediate postoperative period following pediatric renal transplantation has not been systematically evaluated. Our center’s transplant protocol includes a routine DU on postoperative day 3, unless an earlier DU was obtained for a specific indication. We retrospectively evaluated 113 consecutive pediatric renal transplant recipients. Indication for DU (routine vs. non‐routine), timing, results, and graft outcome data were collected. We determined whether the DU result affected patient management. Eighty routine DU examinations were evaluated. Thirty (37.5%) of the 80 routine DUs had abnormalities. Most abnormalities were minor and did not require intervention. One patient with a dysfunctional bladder had mild hydronephrosis; this led to a decision to increase the frequency of bladder catheterization. This was the only intervention based upon the routine DUs. Twenty percent of routine DUs revealed abnormalities that led to a follow‐up study, but none of these studies led to an intervention. The incremental cost of each DU exceeded $1080 and the incremental cost‐effectiveness ratio for a documented change in management exceeded $86 400. Our results suggest that routine post‐transplant DU is not cost‐effective in pediatric renal allograft recipients.