90-minute 99mTc-MDP scintigraphy and 131I-hippuran renography in recently allotransplanted kidneys: evaluation of renal ischemia

Alternating Use of 123I and 131I Hippuran for Routine Postoperative Monitoring of Transplanted Kidneys is Impracticable

During a 7-week period 123I hippuran was used instead of 131I hippuran for all renographies of transplanted kidneys on Wednesdays. Only in well functioning grafts with a diuresis above 2 ml/min during the examination a scintigraphic improvement of renal and upper urinary visualization was obtained. It is concluded that alternating routine use of the expensive 123I hippuran in control of renal grafts cannot be recommended.

Use of 99Tcm Radionuclides to Show Nephrotoxicity of Cyclosporin a in Transplanted Kidneys

In 60 patients, 99Tcm pertechnetate or 99Tcm methylene diphosphonate was injected through an arm vein within 36 h after renal transplantation and repeated 24 or 48 h later. Thirty-one were treated with azathioprine and prednisone, 27 of the grafts had a well-defined peak on the histograms similar to that from the iliac artery histograms at both examinations. In contrast, of the 29 patients treated with cyclosporin A, only 5 of the grafts had a well-defined peak at both examinations. The difference is highly significant. Treatment with cyclosporin A causes a decrease in renal blood flow in the days immediately after transplantation.

Renography and biopsy-verified acute rejection in renal allotransplanted patients receiving cyclosporin A

Acute impairment of renal function caused by cyclosporin A can be hard to differentiate from acute rejection. Therefore, kidney function after cadaveric allograft transplantation was repeatedly determined by renography in 42 patients receiving either high dose cyclosporin A (32 patients) or azathioprine and prednisone (10 patients) until a graft biopsy showed either acute rejection or no rejection within the first 5 postoperative weeks. The graft function as judged from the renograms was significantly poorer when cyclosporin A was used than when azathioprine and prednisone were the immunosuppressants. In the azathioprine and prednisone group a biopsy showing acute rejection was always preceded by a deterioration in the renogram. In cyclosporin A treated patients a graft biopsy following an early deterioration in the renogram showed acute rejection in only 56% of the biopsies. It was not possible to identify a time course or a function level of the renogram that could predict rejection in these patients. It is concluded that graft biopsies should be used liberally to diagnose rejection during cyclosporin A treatment if surgical complications after transplantation have been ruled out. Radionuclide studies may offer an invaluable aid in determining a nonnephrotoxic initial dose of the drug.