Challenges and Considerations When Using Shear Wave Elastography to Evaluate the Transplanted Kidney, With Pictorial Review

The gold standard in evaluating renal allograft dysfunction has traditionally been renal biopsy. However, not only does biopsy come with inherent risks, the time frame from biopsy to detecting renal dysfunction is often inefficient. It is therefore advantageous to have a noninvasive, low‐cost, time‐saving method, such as shear wave elastography (SWE), to detect fibrosis early, to maximize immunosuppressive care. It is important to consider factors that affect tissue stiffness in the kidney, as well as the challenges incurred when using SWE in this anisotropic organ, in order to select the most appropriate patients for this exam.