Ultrasound Utilization in Hospitalized Kidney Transplant Recipients: Useful or Overused?

Abstract

Kidney transplant ultrasonography is an important diagnostic tool in the care of transplant recipients. This modality of nonradiation-based imaging allows for precise and expedient reporting of allograft architecture, which can inform clinical decision-making. However, as with any diagnostic tool, overuse may lead to unnecessary interventions and costs on the healthcare system. To better understand the use of ultrasonography in hospitalized kidney transplant recipients and outcomes of subsequent interventions, we conducted a single-center retrospective study at a large transplant program in Ontario, Canada. We noted that over 30% of admissions resulted in a ultrasonographic survey within the first 24 h of presentation; however, most of these did not change clinical management or lead to a subsequent procedural intervention. Using multivariable logistic regression, we identified predictors for receiving an ultrasound, including time from transplantation, elevated serum creatinine and infectious diagnosis. Procedural interventions (e.g., drain or biopsy) resulted from less than 20% of all ultrasound investigations, with patients closer to the time of index transplant or with elevated serum creatinine values more likely to receive an intervention. In conducting a cost analysis, we estimated that approximately $80 000 CAD per year could be saved with more selective decisions on ultrasound requisitions. Overall, our results indicate that despite being an informative tool, the broad use of ultrasonography in the kidney transplant population may not yield significant changes to transplant care.