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Montgomery JR, Brown CS, Zondlak AN, Walsh KW, Kozlowski JE, Pinsky AM, Herriman EA, Sussman J, Lu Y, Stein EB, Shankar PR, Sung RS, Woodside KJ. CT-measured Cortical Volume Ratio Is an Accurate Alternative to Nuclear Medicine Split Scan Ratio Among Living Kidney Donors. Transplantation 2021; 105:2596-2605. [PMID: 33950636 DOI: 10.1097/tp.0000000000003676] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The 125I-iothalamate clearance and 99mTc diethylenetriamine-pentaacetic acid (99mTc-DTPA) split scan nuclear medicine studies are used among living kidney donor candidates to determine measured glomerular filtration rate (mGFR) and split scan ratio (SSR). The computerized tomography-derived cortical volume ratio (CVR) is a novel measurement of split kidney function and can be combined with predonation estimated GFR (eGFR) or mGFR to predict postdonation kidney function. Whether predonation SSR predicts postdonation kidney function better than predonation CVR and whether predonation mGFR provides additional information beyond predonation eGFR are unknown. METHODS We performed a single-center retrospective analysis of 204 patients who underwent kidney donation between June 2015 and March 2019. The primary outcome was 1-y postdonation eGFR. Model bases were created from a measure of predonation kidney function (mGFR or eGFR) multiplied by the proportion that each nondonated kidney contributed to predonation kidney function (SSR or CVR). Multivariable elastic net regression with 1000 repetitions was used to determine the mean and 95% confidence interval of R2, root mean square error (RMSE), and proportion overprediction ≥15 mL/min/1.73 m2 between models. RESULTS In validation cohorts, eGFR-CVR models performed best (R2, 0.547; RMSE, 9.2 mL/min/1.73 m2, proportion overprediction 3.1%), whereas mGFR-SSR models performed worst (R2, 0.360; RMSE, 10.9 mL/min/1.73 m2, proportion overprediction 7.2%) (P < 0.001 for all comparisons). CONCLUSIONS These findings suggest that predonation CVR may serve as an acceptable alternative to SSR during donor evaluation and furthermore, that a model based on CVR and predonation eGFR may be superior to other methods.
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Affiliation(s)
- John R Montgomery
- Department of Surgery, Section of Transplant Surgery, University of Michigan, Ann Arbor, MI
- Center for Healthcare Outcomes & Policy, University of Michigan, Ann Arbor, MI
| | - Craig S Brown
- Department of Surgery, Section of Transplant Surgery, University of Michigan, Ann Arbor, MI
- Center for Healthcare Outcomes & Policy, University of Michigan, Ann Arbor, MI
| | | | - Kevin W Walsh
- Medical School, University of Michigan, Ann Arbor, MI
| | | | | | - Emily A Herriman
- Department of Surgery, Section of Transplant Surgery, University of Michigan, Ann Arbor, MI
| | - Jeremy Sussman
- Division of General Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| | - Yee Lu
- Division of Nephrology, Department of Medicine, University of Michigan, Ann Arbor, MI
| | - Erica B Stein
- Division of Abdominal Radiology, Department of Radiology, University of Michigan, Ann Arbor, MI
| | - Prasad R Shankar
- Division of Abdominal Radiology, Department of Radiology, University of Michigan, Ann Arbor, MI
- Michigan Radiology Quality Collaborative, University of Michigan, Ann Arbor, MI
| | - Randall S Sung
- Department of Surgery, Section of Transplant Surgery, University of Michigan, Ann Arbor, MI
| | - Kenneth J Woodside
- Department of Surgery, Section of Transplant Surgery, University of Michigan, Ann Arbor, MI
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Abstract
Renal transplantation has become the best treatment for the patients with chronic renal insufficiency. The surgical procedures, immunosuppressive regiments and patient follow-up have evolved especially in the last 10 years. However, the diagnosis for renal transplantation dysfunction remained the same in these years. Serum creatinine levels and estimated glomerular filtration rate calculated by serum creatinine based equations are used in routine patient follow-up. Pelvic ultrasonography and color Doppler ultrasonography are used as a first-line imaging method. Assessment of allograft functions both qualitatively and quantitatively are possible using nuclear medicine procedures. Surgical complications, acute tubular necrosis, subacute and/or acute rejection, infections, toxicity due to immunosuppressive medications, complications relating the collecting system, chronic rejection are the main causes for renal function impairment. The imaging procedures can diagnose the worsening of renal transplant function; however, they still lack the ability to differentiate types of rejection as histopathology or differentiate rejection from other causes of allograft dysfunction. The transplant biopsy gives detailed diagnosis for allograft dysfunction, guide the treatment and therefore it is the preferred diagnostic choice in recent years. On recent years, literature on radionuclide imaging is focused on perfusion analysis for the early diagnosis of renal transplant dysfunction and prognostic use of perfusion parameters, and then this article will focus on these studies and their outcome.
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Affiliation(s)
- Bilge Volkan-Salanci
- Assoc Prof. Dept. of Nuclear Medicine, Hacettepe University, Medical School, Ankara, Turkey
| | - Belkis Erbas
- Prof. Dept. of Nuclear Medicine, Hacettepe University, Medical School, Ankara, Turkey.
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