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Filipov T, Teutsch B, Szabó A, Forintos A, Ács J, Váradi A, Hegyi P, Szarvas T, Ács N, Nyirády P, Deák PÁ. Investigating the role of ultrasound-based shear wave elastography in kidney transplanted patients: correlation between non-invasive fibrosis detection, kidney dysfunction and biopsy results-a systematic review and meta-analysis. J Nephrol 2024:10.1007/s40620-023-01856-w. [PMID: 38427308 DOI: 10.1007/s40620-023-01856-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 11/28/2023] [Indexed: 03/02/2024]
Abstract
INTRODUCTION Interstitial fibrosis and tubular atrophy are leading causes of renal allograft failure. Shear wave elastography could be a promising noninvasive method for providing information on the state of the kidney, with specific regard to fibrosis but currently available data in the literature are controversial. Our study aimed to analyze the correlation between shear wave elastography and various kidney dysfunction measures. METHODS This review was registered on PROSPERO (CRD42021283152). We systematically searched three major databases (MEDLINE, Embase, and CENTRAL) for articles concerning renal transplant recipients, shear wave elastography, fibrosis, and kidney dysfunction. Meta-analytical calculations for pooled Pearson and Spearman correlation coefficients (r) were interpreted with 95% confidence intervals (CIs). Heterogeneity was tested with Cochran's Q test. I2 statistic and 95% CI were reported as a measurement of between-study heterogeneity. Study quality was assessed with the QUADAS2 tool. RESULTS In total, 16 studies were included in our meta-analysis. Results showed a moderate correlation between kidney stiffness and interstitial fibrosis and tubular atrophy, graded according to BANFF classification, on biopsy findings for pooled Pearson (r = 0.48; CI: 0.20, 0.69; I2 = 84%) and Spearman correlations (r = 0.57; CI: 0.35, 0.72; I2 = 74%). When compared to kidney dysfunction parameters, we found a moderate correlation between shear wave elastography and resistive index (r = 0.34 CI: 0.13, 0.51; I2 = 67%) and between shear wave elastography and estimated Glomerular Filtration Rate (eGFR) (r = -0.65; CI: - 0.81, - 0.40; I2 = 73%). All our outcomes had marked heterogeneity. CONCLUSION Our results showed a moderate correlation between kidney stiffness measured by shear wave elastography and biopsy results. While noninvasive assessment of kidney fibrosis after transplantation is an important clinical goal, there is insufficient evidence to support the use of elastography over the performance of a kidney biopsy.
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Affiliation(s)
- Teodóra Filipov
- Department of Interventional Radiology, Heart and Vascular Center, Faculty of Medicine, Semmelweis University, Határőr ut 18, 1122, Budapest, Hungary
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Brigitta Teutsch
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
- Institute for Translational Medicine, Medical School University of Pécs, Pécs, Hungary
- Institute of Pancreatic Diseases, Semmelweis University, Budapest, Hungary
| | - Anett Szabó
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
- Department of Urology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Attila Forintos
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Júlia Ács
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
- Department of Urology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Alex Váradi
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
- Department of Laboratory Medicine, Medical School, University of Pécs, Pécs, Hungary
- Department of Metagenomics, University of Debrecen, Debrecen, Hungary
| | - Péter Hegyi
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
- Institute for Translational Medicine, Medical School University of Pécs, Pécs, Hungary
- Institute of Pancreatic Diseases, Semmelweis University, Budapest, Hungary
| | - Tibor Szarvas
- Department of Urology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
- Department of Urology, University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany
| | - Nándor Ács
- Department of Obstetrics and Gynecology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Péter Nyirády
- Department of Urology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Pál Ákos Deák
- Department of Interventional Radiology, Heart and Vascular Center, Faculty of Medicine, Semmelweis University, Határőr ut 18, 1122, Budapest, Hungary.
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Bogaert S, Suchonos N, Mohan PV, Decruyenaere A, Decruyenaere P, De Waele J, Vermassen F, Van Laecke S, Peeters P, Westhoff TH, Hoste EAJ. Predictive value of the renal resistive index in the immediate postoperative period after kidney transplantation on short- and long-term graft and patient outcomes. J Crit Care 2022; 71:154112. [PMID: 35843045 DOI: 10.1016/j.jcrc.2022.154112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 06/05/2022] [Accepted: 07/01/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION During the postoperative stay in the intensive care unit after kidney transplantation, the renal resistive index (RI) is routinely measured. An increased RI, measured months posttransplant, is associated with a higher mortality. We wanted to investigate the value of the RI immediately posttransplant in predicting both short- and long-term outcome. METHODS We performed a retrospective single-center study. The RI was collected <48 h posttransplant in patients undergoing kidney transplantations between 2005 and 2014. Short-term outcome was evaluated by delayed graft function (DGF). The long-term endpoints were kidney function and mortality at 30 days, 1 year and 5 years. RESULTS We included 478 recipients, 91.4% of whom reached the end of the 5-year follow-up. A higher RI < 48 h posttransplant was significantly associated with DGF. This association was particularly strong in patients receiving grafts from donors after brain death and expanded criteria donors. A higher RI also correlated with mortality and death with functioning graft but not with graft failure. After adjustment for confounders, we found an association between increased RI and DGF, but not with long-term kidney function or mortality. CONCLUSION The RI routinely measured <48 h posttransplant is an independent predictor of short-term kidney function.
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Affiliation(s)
- Stijn Bogaert
- Faculty of Medicine, Ruhr-University Bochum, Bochum, Germany; Intensive Care Unit, Ghent University Hospital, Ghent University, Ghent, Belgium.
| | - Nicole Suchonos
- Faculty of Medicine, Ruhr-University Bochum, Bochum, Germany
| | | | | | | | - Jan De Waele
- Intensive Care Unit, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Frank Vermassen
- Department of Vascular Surgery, Ghent University Hospital, Ghent, Belgium
| | | | | | - Timm H Westhoff
- Faculty of Medicine, Ruhr-University Bochum, Bochum, Germany
| | - Eric A J Hoste
- Intensive Care Unit, Ghent University Hospital, Ghent University, Ghent, Belgium; Transplantation Center, Ghent University Hospital, Ghent, Belgium; Research Foundation-Flanders (FWO), Brussels, Belgium
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Azzouz S, Chen A, Ekmekjian T, Cantarovich M, Baran D, Sandal S. The role of renal resistive index as a prognostic tool in kidney transplantation: a systematic review. Nephrol Dial Transplant 2022; 37:1552-1565. [DOI: 10.1093/ndt/gfac149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Indexed: 11/14/2022] Open
Abstract
ABSTRACT
Background
In kidney transplant recipients (KTRs), observational data have reported conflicting findings about the utility of renal resistive index (RRI) in determining outcomes. We aimed to synthesize the current literature and determine the prognostic role of RRI in KTRs.
Methods
We conducted a systematic review to assess the role of RRI in predicting death, graft failure, graft function, and proteinuria. Of the 934 titles/abstracts reviewed, 26 studies were included. There was significant heterogeneity in RRI measurements and thresholds as well as in analytic methods and a meta-analysis could not be performed.
Results
All included studies were observational and included 7049 KTRs. Eight studies analyzed death, of which five reported a significant association with higher RRI. In the remaining three, small sample sizes and lower/multiple RRI thresholds may have limited detection of a statistically significant difference. Three studies investigated all-cause graft failure and an association with RRI was reported but varied by time of RRI measurement. Three out of five studies that analyzed a composite of patient and graft outcomes reported an association with RRI. Evidence analyzing death-censored graft failure, graft failure (unclear if death-censored or all-cause), measures of graft function, and proteinuria were conflicting. Most studies had a moderate to high risk of bias.
Conclusions
RRI likely has a prognostic role in predicting patient outcomes, reflecting patient systemic vascular disease burden rather than graft hemodynamics. Since cardiovascular diseases are a major cause of death and graft loss, RRI may be explored as a non-invasive tool to risk stratify KTRs.
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Affiliation(s)
- Safaa Azzouz
- Faculty of Medicine, McGill University Health Centre, Montreal, QC, Canada
| | - Anjellica Chen
- Faculty of Medicine, McGill University Health Centre, Montreal, QC, Canada
| | - Taline Ekmekjian
- Medical Libraries, McGill University Health Centre, Montreal, QC, Canada
| | - Marcelo Cantarovich
- Division of Nephrology, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Dana Baran
- Division of Nephrology, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Shaifali Sandal
- Division of Nephrology, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
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Zhang J, Chen GD, Qiu J, Tan Y, Liu GC, Chen LZ, Jia W, Fu W, Wang CX. Color Doppler Ultrasound and Hemodynamics for Evaluating Graft Dysfunction in Recurrent Immunoglobulin A Nephropathy. Ann Transplant 2021; 26:e931736. [PMID: 34413279 PMCID: PMC8409140 DOI: 10.12659/aot.931736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The aim of this study was to investigate the diagnostic and prognostic utility of color Doppler ultrasound for graft dysfunction in recurrent immunoglobulin A nephropathy (IgAN). MATERIAL AND METHODS We selected a series of 78 biopsies diagnostic of recurrent IgAN following living-donor transplantation from July 2004 to January 2019. Based on Lee's classification, Doppler parameters in different degrees of histopathological injury were retrospectively analyzed. RESULTS The 4-year cumulative graft survival rate after biopsy was 66.3%, and the difference among the Kaplan-Meier curves of Lee's classification (P<0.01) was significant. Doppler parameters showed that echo enhancement, decreasing blood flow distribution, decreasing end-diastolic velocity (EDV) of the main renal artery (MRA), segmental renal atery (SRA) and interlobar renal artery (IRA), and an elevated resistance index (RI) of the arcuate renal artery (ARA) were significantly different among grades I-V of Lee's classification (P<0.05). Logistic multivariate analysis indicated that echo enhancement (HR 13.6, 95% CI 2.7-68.4) and decreasing EDV of the SRA (HR 1.1 for a 1-cm/s, 95% CI 1.0-1.2) were independent predictors of severe injury (IV-V). The ROC curve fitted by echo enhancement and decreasing EDV of the SRA had an area under the curve of 0.87. The cutoff was 17.5 cm/s (decreasing EDV of the SRA) without echo enhancement. The sensitivity and specificity were 72.2% and 91.7%, respectively. CONCLUSIONS Color Doppler ultrasound successfully evaluated the graft dysfunction in recurrent IgAN; a decreasing EDV of the SRA indicated severe histopathological injury and poor prognosis.
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Affiliation(s)
- Jin Zhang
- Department of Urology, Guangzhou Women's and Children's Medical Center, Guangzhou, Guangdong, China (mainland).,Department of Organ Transplant, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China (mainland)
| | - Guo-Dong Chen
- Department of Organ Transplant, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China (mainland)
| | - Jiang Qiu
- Department of Organ Transplant, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China (mainland)
| | - Yang Tan
- Department of Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China (mainland)
| | - Guo-Chang Liu
- Department of Urology, Guangzhou Women's and Children's Medical Center, Guangzhou, Guangdong, China (mainland)
| | - Li-Zhong Chen
- Department of Organ Transplant, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China (mainland)
| | - Wei Jia
- Department of Urology, Guangzhou Women's and Children's Medical Center, Guangzhou, Guangdong, China (mainland)
| | - Wen Fu
- Department of Urology, Guangzhou Women's and Children's Medical Center, Guangzhou, Guangdong, China (mainland)
| | - Chang-Xi Wang
- Department of Organ Transplant, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China (mainland)
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de Freminville JB, Vernier LM, Roumy J, Patat F, Gatault P, Sautenet B, Barbet C, Longuet H, Merieau E, Buchler M, Halimi JM. Early changes in renal resistive index and mortality in diabetic and nondiabetic kidney transplant recipients: a cohort study. BMC Nephrol 2021; 22:62. [PMID: 33607945 PMCID: PMC7893742 DOI: 10.1186/s12882-021-02263-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 02/02/2021] [Indexed: 12/23/2022] Open
Abstract
Background Renal resistive index (RI) predicts mortality in renal transplant recipients (RTR). However, its predictive value may be different according to the time of measurement. We analysed RI changes between 1 month and 3 months after transplantation and its predictive value for death with a functioning graft (DWFG). Methods We conducted a retrospective study in 1685 RTR between 1985 and 2017. The long-term predictive value of changes in RI value from 1 month to 3 months was assessed in diabetic and non-diabetic RTR. Results Best survival was observed in RTR with RI < 0.70 both at 1 and 3 months, and the worst survival was found in RTR with RI ≥ 0.70 both at 1 and 3 months (HR = 3.77, [2.71–5.24], p < 0.001). The risk of DWFG was intermediate when RI was < 0.70 at 1 month and ≥ 0.70 at 3 months (HR = 2.15 [1.29–3.60], p = 0.003) and when RI was ≥0.70 at 1 month and < 0.70 at 3 months (HR = 1.90 [1.20–3.03], p = 0.006). In diabetic RTR, RI was significantly associated with an increased risk of death only in those with RI < 0.70 at 1 month and ≥ 0.70 at 3 months (HR = 4.69 [1.07–20.52], p = 0.040). RI considered as a continuous variable at 1 and 3 months was significantly associated with the risk of DWFG in nondiabetic but not in diabetic RTR. Conclusion RI changes overtime and this impacts differently diabetic and nondiabetic RTR. RI short-term changes have a strong prognosis value and refines the risk of DWFG associated with RI. Supplementary Information The online version contains supplementary material available at 10.1186/s12882-021-02263-8.
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Affiliation(s)
- Jean-Baptiste de Freminville
- Néphrologie-Immunologie Clinique, Hôpital Bretonneau, CHU Tours, Tours, France. .,University of Tours, Tours, France.
| | | | - Jérome Roumy
- Imagerie Médicale, Hôpital Bretonneau, CHU Tours, Tours, France.,CIC-IT 1415, CHU Tours, Tours, France
| | - Frédéric Patat
- University of Tours, Tours, France.,Imagerie Médicale, Hôpital Bretonneau, CHU Tours, Tours, France.,CIC-IT 1415, CHU Tours, Tours, France
| | - Philippe Gatault
- Néphrologie-Immunologie Clinique, Hôpital Bretonneau, CHU Tours, Tours, France.,University of Tours, Tours, France.,EA4245, University of Tours, Tours, France
| | - Bénédicte Sautenet
- Néphrologie-Immunologie Clinique, Hôpital Bretonneau, CHU Tours, Tours, France.,University of Tours, Tours, France
| | - Christelle Barbet
- Néphrologie-Immunologie Clinique, Hôpital Bretonneau, CHU Tours, Tours, France
| | - Hélène Longuet
- Néphrologie-Immunologie Clinique, Hôpital Bretonneau, CHU Tours, Tours, France
| | - Elodie Merieau
- Néphrologie-Immunologie Clinique, Hôpital Bretonneau, CHU Tours, Tours, France
| | - Matthias Buchler
- Néphrologie-Immunologie Clinique, Hôpital Bretonneau, CHU Tours, Tours, France.,University of Tours, Tours, France.,EA4245, University of Tours, Tours, France
| | - Jean-Michel Halimi
- Néphrologie-Immunologie Clinique, Hôpital Bretonneau, CHU Tours, Tours, France.,University of Tours, Tours, France.,EA4245, University of Tours, Tours, France
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6
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Bogaert S, Peeters P, Suchonos N, Decruyenaere A, Decruyenaere P, Vermassen F, Hoste EA. WITHDRAWN: Impact on Delayed Graft Function of the Renal Resistive Index in the Immediate Postoperative Period After Kidney Transplantation: A Cohort Analysis. Transplant Proc 2020:S0041-1345(19)31053-X. [PMID: 32703673 DOI: 10.1016/j.transproceed.2019.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 09/04/2019] [Indexed: 11/19/2022]
Abstract
This article has been withdrawn at the request of the author(s) and/or editor. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal.
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Affiliation(s)
- Stijn Bogaert
- Intensive Care Unit, Ghent University Hospital, Ghent, Belgium; Ruhr University Bochum, St. Elisabeth-Hospital, Bochum, Germany
| | | | - Nicole Suchonos
- Ruhr University Bochum, St. Elisabeth-Hospital, Bochum, Germany
| | | | | | - Frank Vermassen
- Department of Vascular Surgery, Ghent University Hospital, Ghent, Belgium
| | - Eric Aj Hoste
- Intensive Care Unit, Ghent University Hospital, Ghent, Belgium; Research-Foundation (FWO), Brussels, Belgium
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7
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Magnetti M, Leonardi G, Guarena C, Dolla C, Tarragoni R, Abbasciano I, Fop F, Tallia C, Giordano F, Verri A, Biancone L. Hemodialysis arteriovenous fistula ligation after renal transplantation: Impact on graft resistive index. J Vasc Access 2020; 22:129-134. [PMID: 32524867 DOI: 10.1177/1129729820927240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Kidney allograft resistive index (RI) is prognostic for graft and recipient survivals. Recipient hemodynamics could influence RI. In particular, dialysis arteriovenous fistula (AVF) has been involved in heart function changes, reversible after AVF ligation. Knowledge about AVF and RI is lacking. In this study, we prospectively evaluated RI changes after AVF ligation in kidney transplanted patients. METHODS We enrolled 22 stable transplanted patients. Mean RI was measured before AVF ligation (T0), 18 to 24 h (T1) and 6 months (T6) after surgery; mean blood pressure (mBP), heart rate (HR), serum creatinine (sCr), estimated glomerular filtration rate (eGFR), 24 h proteinuria (24 h-P), immunosuppressive drug blood levels (IS) and antihypertensive drugs were also recorded. RESULTS AVF ligation was performed 3.1 years (IQR: 2.1-3.8) after transplantation. Median AVF flow (Qa) was 1868 mL/min (IQR: 1538-2712) and 8 AVF were classified as high flow (Qa ≥ 2 L/min). At baseline, median sCr was 1.32 mg/dL (IQR: 1.04-1.76) and median eGFR was 57.1 mL/min. Median RI was 0.71 at T0, 0.69 at T1, 0.66 at T6. RI reduction at T1 and T6 was statistically significant (p < 0.05 and p < 0.001 respectively); in particular, 90.4% of patients had persistently improved values at T6. Furthermore, mBP increased while HR decreased. These changes were independent from sCr, 24 h-P, IS, antihypertensive drugs number, Qa and AVF type. CONCLUSIONS AVF ligation improves kidney allograft RI; it may reflect better kidney perfusion.
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Affiliation(s)
- Marica Magnetti
- S.C. Nefrologia, Dialisi e Trapianto U, AOU Città della Salute e della Scienza, Turin, Italy
| | - Gianluca Leonardi
- S.C. Nefrologia, Dialisi e Trapianto U, AOU Città della Salute e della Scienza, Turin, Italy
| | - Cesare Guarena
- S.C. Nefrologia, Dialisi e Trapianto U, AOU Città della Salute e della Scienza, Turin, Italy
| | - Caterina Dolla
- S.C. Nefrologia, Dialisi e Trapianto U, AOU Città della Salute e della Scienza, Turin, Italy
| | - Rita Tarragoni
- S.C. Nefrologia, Dialisi e Trapianto U, AOU Città della Salute e della Scienza, Turin, Italy
| | - Isabella Abbasciano
- S.C. Nefrologia, Dialisi e Trapianto U, AOU Città della Salute e della Scienza, Turin, Italy
| | - Fabrizio Fop
- S.C. Nefrologia, Dialisi e Trapianto U, AOU Città della Salute e della Scienza, Turin, Italy
| | - Caterina Tallia
- S.C. Chirurgia Vascolare, AOU Città della Salute e della Scienza, Turin, Italy
| | - Federica Giordano
- S.C. Chirurgia Vascolare, AOU Città della Salute e della Scienza, Turin, Italy
| | - Aldo Verri
- S.C. Chirurgia Vascolare, AOU Città della Salute e della Scienza, Turin, Italy
| | - Luigi Biancone
- S.C. Nefrologia, Dialisi e Trapianto U, AOU Città della Salute e della Scienza, Turin, Italy
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Kolonko A, Król R, Chudek J, Skrzypek M, Cierpka L, Więcek A. Early graft function and intrarenal resistant index after kidney transplantation using Biolasol-A new solid organ preservation fluid. Artif Organs 2020; 44:1211-1219. [PMID: 32464704 DOI: 10.1111/aor.13742] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 05/16/2020] [Accepted: 05/19/2020] [Indexed: 12/14/2022]
Abstract
Biolasol is a newly developed preserving solution for cold organ storage prior to transplantation. To date, only animal model experiments results are available. The aim of this single-center analysis was to summarize the clinical experience concerning the early post-transplant course of kidney grafts preserved with Biolasol in comparison with other preservation solutions. Before transplantation, 173 kidney grafts were preserved using Biolasol and 240 organs with other solutions (University of Wisconsin-UW, Institute Georges Lopez-IGL-1, or StoreProtect Plus solutions). Early graft function was defined based on serum creatinine concentration at day 3 (<3 mg/dL-immediate graft function, IGF or >3 mg/dL-slow graft function, SGF) or the need of dialysis therapy during first post-operative week (delayed graft function, DGF). The analysis included intrarenal resistive indices measured by Doppler sonography early after transplantation and before discharge from the hospital. IGF was more frequent in patients with organs preserved with IGL-1 (33.5%) and StoreProtect Plus (38.8%) than Biolasol (18.5%), whereas there was no difference in the occurrence of DGF. Both initial and discharge median resistance index values were significantly higher in the Biolasol subgroup (0.77 and 0.75) than in all three other subgroups (P values for all comparisons <.001), also after 1:1 propensity score matching for baseline characteristics. Multiple logistic regression analysis based on the propensity score-matched cohort revealed that the use of Biolasol solution [OR 0.59 (0.35-0.98); P < .05] independently decreased the occurrence of IGF. In our single-center clinical experience, kidney preservation using Biolasol solution was associated with significantly higher intrarenal resistant index in comparison with other preservation fluids, as well as worse early graft function than in the IGL-1 and the StoreProtect Plus subgroups. Long-term follow-up is needed in order to assess the kidney graft and patient survival.
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Affiliation(s)
- Aureliusz Kolonko
- Department of Nephrology, Transplantation and Internal Medicine, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - Robert Król
- Department of General, Vascular and Transplant Surgery, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - Jerzy Chudek
- Department of Internal Medicine and Oncological Chemotherapy, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - Michał Skrzypek
- Department of Biostatistics, School of Health Sciences in Bytom, Medical University of Silesia, Katowice, Poland
| | - Lech Cierpka
- Department of General, Vascular and Transplant Surgery, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - Andrzej Więcek
- Department of Nephrology, Transplantation and Internal Medicine, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
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9
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Jeong DS, He W, Shin MH, Choi NK. Resistive index as a predictor of early failure of kidney transplantation. KOREAN JOURNAL OF TRANSPLANTATION 2019; 33:55-59. [PMID: 35769409 PMCID: PMC9188929 DOI: 10.4285/jkstn.2019.33.3.55] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 07/09/2019] [Accepted: 07/12/2019] [Indexed: 12/23/2022] Open
Abstract
Background Ultrasonography is a simple and noninvasive examination that can be easily performed after renal transplantation because of the lack of toxicity. The resistive index (RI) was measured using Doppler ultrasound at 7 days postoperatively in patients who underwent renal transplantation. The study aimed to determine the risk of graft loss and premature death within 1 year after transplantation. Methods This study was conducted from January 2011 to October 2017 and involved 97 patients who underwent renal transplantation at the Chosun University Hospital, Kwangju, Korea. Brain-dead donors were selected. Several parameters were assessed as recipient variables. In addition, postoperative delayed renal function and complications were examined. At 7 days after surgery, the RI was measured in all patients (the mean value of three measurements taken at different positions was used). Results Of the 97 patients, 40 had an RI of ≥0.8 or greater. Of these, four patients died, and a total of seven developed transplant failure. Logistic regression analysis was conducted to predict the risk of transplant failure and mortality based on complex influences of the relevant variables. The RI showed a relative risk value of 12.711 for transplant failure (P=0.003) and was significantly associated with mortality (P=0.001). Conclusions The RI was highly correlated with graft loss and recipient mortality after renal transplantation. Measurement of the RI after renal transplantation may lead to a more aggressive management of high-risk patients, and consequently improve the post-transplantation outcome.
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Affiliation(s)
- Dai Sik Jeong
- Division of Hepato-biliary and Transplantation, Department of Surgery, Chosun University Hospital, Gwangju, Korea
| | - WeiJie He
- Division of Hepato-biliary and Transplantation, Department of Surgery, Chosun University Hospital, Gwangju, Korea
| | - Min Ho Shin
- Division of Hepato-biliary and Transplantation, Department of Surgery, Chosun University Hospital, Gwangju, Korea
| | - Nam Kyu Choi
- Division of Hepato-biliary and Transplantation, Department of Surgery, Chosun University Hospital, Gwangju, Korea
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10
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Bellos I, Perrea DN, Kontzoglou K. Renal resistive index as a predictive factor of delayed graft function: A meta-analysis. Transplant Rev (Orlando) 2019; 33:145-153. [DOI: 10.1016/j.trre.2019.03.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 03/24/2019] [Accepted: 03/26/2019] [Indexed: 02/08/2023]
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11
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Relationship Between Individual Components of the Extended-Criteria Donor Definition and the First Post-transplant Kidney Graft Resistance Index, Measured by Doppler Sonography. Transplant Proc 2018; 50:1680-1685. [PMID: 30056881 DOI: 10.1016/j.transproceed.2017.12.061] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 12/19/2017] [Indexed: 11/21/2022]
Abstract
BACKGROUND Despite an increasing utilization of kidneys procured from expanded-criteria donors, little is known about the effects of particular expanded-criteria donors definition components, that is, hypertension, increased creatinine prior to procurement, and cerebrovascular cause of death on the kidney graft Doppler parameters measured shortly after transplantation, whose increased values are associated with unfavorable outcomes. Hence, we analyzed the relationship between expanded-criteria donors components and resistance index values measured within 2 to 3 days post-transplant. MATERIAL AND METHODS The initial post-transplant resistance index value was measured in 676 consecutive successful first cadaveric kidney graft recipients without delayed graft function or early acute rejection episode. We analyzed resistance index values in 460 patients transplanted with organs from donors <50 years and in 216 recipients with organs from donors >50 years old. RESULTS In general, expanded-criteria donors status did not influence the initial resistance index values in the whole study group. Unexpectedly, in older donor groups, both the occurrence of donor hypertension and cerebrovascular cause of death resulted in significantly lower resistance index values in kidney graft recipients (0.73 ± 0.10 vs 0.76 ± 0.11 in the non-hypertension group, P = .013 and 0.74 ± 0.11 vs 0.78 ± 0.10 in the non-cerebrovascular cause of death group, P = .015, respectively). In the Cox proportional regression model for graft survival, cerebrovascular cause of death was increasing the risk of graft loss by 55%, while recipient's age had the opposite effect, decreasing the risk of graft loss by 2% per year. CONCLUSIONS Regardless of the limited influence of expanded-criteria donor status on first post-transplant resistance index value, the long-term observation shows moderate but significantly worse kidney graft survival, mostly as a result of the cerebrovascular cause of donor's death.
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12
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Moser MAJ, Ginther N, Luo Y, Beck G, Ginther R, Ewen M, Matsche-Neufeld R, Shoker A, Sawicki G. Early experience with hypothermic machine perfusion of living donor kidneys - a retrospective study. Transpl Int 2017; 30:706-712. [PMID: 28390094 DOI: 10.1111/tri.12964] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 12/31/2016] [Accepted: 03/24/2017] [Indexed: 02/06/2023]
Abstract
Although hypothermic machine perfusion (HMP) has been shown to be beneficial to deceased donor kidneys, the effect of HMP on living donor kidneys (LDK) is unknown. LDK are subjected to minutes of normothermic ischemia at the time of recovery. Comparison of 16 LDK preserved by HMP with 16 LDK preserved by static cold storage (SCS). Outcomes of interest are resistive indices (RI), both while on HMP and postoperatively, and creatinine clearance (CrCl). Injury markers NGAL and LDH were seen in the perfusate of LDK in amounts similar to what is found for donation after neurological determination of death kidneys. Compared to SCS kidneys, CrCl was significantly higher in the HMP group from days 2 through 7 post-transplant [ie: day 7 (78.8 ± 5.4 vs. 54.0 ± 4.6 ml/min, P = 0.005)]. CrCl at 1 year was higher in the HMP group (81.2 ± 5.8 vs. 70.0 ± 5.3 ml/min, P = 0.03). Early post-transplant RI was significantly lower in the HMP group (0.61 ± 0.02 vs. 0.71 ± 0.02, P < 0.0001). Our data support the assertion that injury does occur during LDK procurement and suggest that some of this injury may be reversed with HMP, resulting in more favorable early RI and graft function compared to SCS kidneys.
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Affiliation(s)
- Michael A J Moser
- Department of Surgery, University of Saskatchewan, Saskatoon, SK, Canada.,Saskatchewan Renal Transplant Program, Saskatoon, SK, Canada
| | - Nathan Ginther
- Department of Surgery, University of Saskatchewan, Saskatoon, SK, Canada
| | - Yigang Luo
- Department of Surgery, University of Saskatchewan, Saskatoon, SK, Canada.,Saskatchewan Renal Transplant Program, Saskatoon, SK, Canada
| | - Gavin Beck
- Department of Surgery, University of Saskatchewan, Saskatoon, SK, Canada.,Saskatchewan Renal Transplant Program, Saskatoon, SK, Canada
| | - Ronn Ginther
- Saskatchewan Renal Transplant Program, Saskatoon, SK, Canada
| | - Marla Ewen
- Saskatchewan Renal Transplant Program, Saskatoon, SK, Canada
| | | | - Ahmed Shoker
- Saskatchewan Renal Transplant Program, Saskatoon, SK, Canada.,Department of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Grzegorz Sawicki
- Department of Pharmacology, University of Saskatchewan, Saskatoon, SK, Canada.,Department of Clinical Chemistry, Medical University of Wroclaw, Wroclaw, Poland
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13
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Mwipatayi BP, Suthananthan AE, Daniel R, Rahmatzadeh M, Thomas SD, Phillips M, Vijayan V. Relationship Between 'Immediate' Resistive Index Measurement After Renal Transplantation and Renal Allograft Outcomes. Transplant Proc 2017; 48:3279-3284. [PMID: 27931569 DOI: 10.1016/j.transproceed.2016.09.043] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 08/11/2016] [Accepted: 09/01/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND The arterial resistive index, also referred to as the resistive index (RI) or Pourcelot Index, is a measure of pulsatile blood flow. Previous studies have demonstrated the usefulness of the RI as a predictor of allograft outcomes based on RI measurement in the later stages after transplantation. However, there is little evidence of the predictive value of "immediate" RI measurement within 24 hours after transplantation. METHODS We performed a retrospective cohort study of 305 adult renal transplants carried out between 2003 and 2013. The associations between immediate RI measurement (within 24 hours after transplantation) and donor, recipient, and surgical factors were analyzed. In addition, the correlations between immediate RI measurement and renal allograft outcomes, including delayed graft function (DGF) and transplant failure (TF), also were evaluated. RESULTS From a cohort of 305 patients, 52 were excluded on the basis of on confounding factors. Of the remaining 253 patients, the mean age was 48.4 years, 57.5% were male, and approximately one-third had diabetes. Two hundred twenty-six patients had an RI < 0.8, whereas only 27 had an RI ≥ 0.8. Significant associations were found between elevated RI (≥0.8) and both DGF (odds ratio = 3.22, P = .006) and TF (odds ratio = 3.54, P = .008). CONCLUSIONS Immediate RI measurement after renal transplantation is a strong predictor of both DGF and TF.
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Affiliation(s)
- B P Mwipatayi
- Department of Vascular Surgery, Royal Perth Hospital, Perth, Australia; School of Surgery, Faculty of Medicine, Dentistry and Health Sciences, University of Western Australia, Perth, Australia.
| | - A E Suthananthan
- Department of Vascular Surgery, Royal Perth Hospital, Perth, Australia
| | - R Daniel
- Department of Vascular Surgery, Royal Perth Hospital, Perth, Australia
| | - M Rahmatzadeh
- Department of Vascular Surgery, Royal Perth Hospital, Perth, Australia
| | - S D Thomas
- University of New South Wales, Sydney, Australia; Prince of Wales Hospital, Sydney, Australia
| | - M Phillips
- Perkins Institute of Medical Research, Royal Perth Hospital and University of Western Australia, Perth, Australia
| | - V Vijayan
- Department of Vascular Surgery, Alexandra Hospital, Singapore
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14
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Melek E, Baskın E, Gulleroglu K, Uslu N, Kırnap M, Moray G, Haberal M. The predictive value of resistive index obtained by Doppler ultrasonography early after renal transplantation on long-term allograft function. Pediatr Transplant 2017; 21. [PMID: 27900821 DOI: 10.1111/petr.12860] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/03/2016] [Indexed: 10/20/2022]
Abstract
DUSG is a useful diagnostic tool for the follow-up of renal transplant recipients. The measurement of intrarenal arterial RI by DUSG has been proven to predict short-term AF. The aim of the study was to evaluate the predictive value of DUSG performed during the early after RTx on long-term AF. Seventy patients were enrolled into study. DUSG was performed at third and seventh days after RTx. Patients were divided into two groups according to rate of recovery of graft function as patients with normal graft function and abnormal graft function. Although the RI values were correlated with the AF early after transplantation, they were not correlated with long-term AF. However, the rate of recovery of graft function at early period after RTx was correlated with creatinine level at first year and with glomerular filtration rate at first year and last visit. Although the RI has no predictive value for long-term AF, the rate of recovery of graft function at early post-transplantation period has predictive value for long-term AF; patients with higher RI values early after RTx should be followed carefully for the development of chronic allograft injury.
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Affiliation(s)
- Engin Melek
- Division of Pediatric Nephrology, Baskent University, Ankara, Turkey.,Division of Pediatric Nephrology, Balcali Hospital, Cukurova University, Adana, Turkey
| | - Esra Baskın
- Division of Pediatric Nephrology, Baskent University, Ankara, Turkey
| | - Kaan Gulleroglu
- Division of Pediatric Nephrology, Baskent University, Ankara, Turkey
| | - Nihal Uslu
- Division of Radiology, Baskent University, Ankara, Turkey
| | - Mahir Kırnap
- Division of General Surgery, Baskent University, Ankara, Turkey
| | - Gokhan Moray
- Division of General Surgery, Baskent University, Ankara, Turkey
| | - Mehmet Haberal
- Division of General Surgery, Baskent University, Ankara, Turkey
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15
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Shakeri Bavil A, Mirfakhraei A, Tayebi Khosroshahi H, Chokhachizadeh Moghadam R, Fouladi DF. The inability of an early post-transplantation intrarenal resistive index to predict renal allograft function at 12 weeks after engraftment in young adults. Acta Radiol 2016; 57:1402-1408. [PMID: 26013023 DOI: 10.1177/0284185115587321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background The intrarenal resistive index (RI) is a promising tool for predicting renal graft outcomes. Due to the complexity of graft function and the presence of diverse contributing factors, however, the available data are inconclusive. Purpose To examine the performance of the RI 1 week after transplant in predicting allograft function at week 12, with an emphasis on the type of intrarenal artery used in the examination. Material and Methods A total of 58 first-time living-donor kidney-allograft-transplantation patients aged less than 50 years underwent Doppler ultrasonography (US) of the intrarenal arteries 1 week after engraftment. The RI was calculated for both the segmental (RI-C) and interlobar-arcuate (RI-P) arteries. Serum creatinine level and the creatinine reduction ratio (CRR) were determined at weeks 1 and 12 post transplantation. Results While the RI did not correlate with serum creatinine level and CRR at week 1, significant correlations were present between the RI and serum creatinine level (r = 0.28, P = 0.03 for both RI-C and RI-P) and CRR (r = -0.25, P = 0.05 for both RI-C and RI-P) at week 12. The sensitivity, specificity, positive predictive value, and negative predictive value of using RI-C in predicting abnormal 12-week serum creatinine level were 51.2%, 52.9%, 72.4%, and 31.3%, respectively; and 53.7%, 47.1%, 70.9%, and 29.6% for RI-P, respectively ( P > 0.99 for all comparisons). Conclusion Early post-transplantation RI correlates significantly with both serum creatinine level and creatinine reduction ratio 12 weeks after engraftment with intermediate predictive accuracy.
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Affiliation(s)
- Abolhassan Shakeri Bavil
- Department of Radiology, Imam Reza Teaching Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Alirezal Mirfakhraei
- Department of Radiology, Imam Reza Teaching Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hamid Tayebi Khosroshahi
- Department of Nephrology, Imam Reza Teaching Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
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16
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Determinant Variables of Resistive Index in Early Renal Transplant Recipients. Transplant Proc 2016; 48:1955-61. [DOI: 10.1016/j.transproceed.2016.04.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 04/25/2016] [Indexed: 12/25/2022]
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17
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Schwenger V, Hankel V, Seckinger J, Macher-Göppinger S, Morath C, Zeisbrich M, Zeier M, Kihm LP. Contrast-enhanced ultrasonography in the early period after kidney transplantation predicts long-term allograft function. Transplant Proc 2015; 46:3352-7. [PMID: 25498050 DOI: 10.1016/j.transproceed.2014.04.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Accepted: 04/22/2014] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Real-time contrast-enhanced sonography (CES) can assess microvascular tissue perfusion using gas-filled microbubbles. The purpose of the study was to evaluate the feasibility of early CES in predicting long-term kidney allograft function in comparison to color Doppler ultrasonography (CDUS). METHODS We prospectively studied 68 consecutive kidney transplant recipients using CES and conventional CDUS investigation 1 week after transplantation. Transplant tissue perfusion imaging was performed by low-power imaging during intravenous administration of the sonocontrast SonoVue. Renal tissue perfusion was assessed quantitatively using flash replenishment kinetics of microbubbles to estimate renal blood flow (RBF). The obtained sonography values were correlated with clinical data 1 week up to 1 year after transplantation. RESULTS In contrast with conventional CDUS resistive indices, RBF estimated by CES 1 week posttransplantation significantly correlated with kidney function after 1 year (r = 0.67; P < .001). Determination of RBF by CES revealed a significant correlation with donor age but not recipient age, whereas conventional CDUS resistive index was significantly correlated to recipient age (r = 0.54; P < .001) but not donor age. Furthermore RBF was associated with vascular fibrosis and intimal thickening of the engraftment biopsies. CONCLUSION This is the first prospective study demonstrating the prognostic value of CES early after kidney transplantation. In contrast with CDUS, CES reveals information about kidney allograft perfusion independent of recipient vascular compliance.
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Affiliation(s)
- V Schwenger
- Department of Nephrology, University Hospital, Heidelberg, Germany
| | - V Hankel
- Department of Radiation Oncology, University of Munich, Munich, Germany
| | - J Seckinger
- Department of Nephrology, University Hospital, Heidelberg, Germany
| | | | - C Morath
- Department of Nephrology, University Hospital, Heidelberg, Germany
| | - M Zeisbrich
- Department of Nephrology, University Hospital, Heidelberg, Germany
| | - M Zeier
- Department of Nephrology, University Hospital, Heidelberg, Germany
| | - L P Kihm
- Department of Nephrology, University Hospital, Heidelberg, Germany; Department of Endocrinology, University Hospital, Heidelberg, Germany.
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18
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Saracino A, Santarsia G. Effect of Donor- and Recipient-Related Factors on Arterial Resistance Index After Kidney Transplant. Transplant Proc 2015; 47:2130-4. [PMID: 26361660 DOI: 10.1016/j.transproceed.2015.04.104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 03/13/2015] [Accepted: 04/15/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND The assessment of color Doppler resistance index (RI) of the intra-renal arteries has been shown to be a good predictor of short-term and long-term graft survival after kidney transplant. In this study, we investigated the influence of donor- and recipient-related factors on RI evaluated early after kidney transplant. METHODS We prospectively analyzed 90 kidney transplant patients who underwent RI assessment within the first month after the transplant, subdivided into 2 groups according their RI values lower (group A) or higher (group B) than 0.646 (median value). RESULTS Patients in group A had a lower human leukocyte antigen (HLA) mismatch number (3.3 ± 1 versus 3.9 ± 0.9, P = .007) and were significantly younger (42.8 ± 11 years versus 47.8 ± 11 years, P = .03) than patients in group B. All the others variables examined were not significantly different between the 2 groups. Multivariate logistic regression analysis confirmed that HLA mismatch number (P = .03) and recipient age (P = .03) are independent predictors of RI. CONCLUSIONS Our data suggest that HLA mismatches and donor age can influence recipient kidney vascular resistance in the early period after transplantation.
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Affiliation(s)
- A Saracino
- Basilicata Referral Centre for Transplantation, Hospital of Matera, Matera, Italy.
| | - G Santarsia
- Basilicata Referral Centre for Transplantation, Hospital of Matera, Matera, Italy
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19
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Kolonko A, Chudek J, Więcek A. Initial kidney graft resistance index and the long-term cardiovascular mortality in transplanted patients: a paired grafts analysis. Nephrol Dial Transplant 2015; 30:1218-1224. [PMID: 25839739 DOI: 10.1093/ndt/gfv083] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Accepted: 03/04/2015] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND Cardiovascular complications remain the most frequent cause of death in kidney transplant recipients. We analysed the prognostic value of early measured resistance index (RI) in the aspect of long-term cardiovascular mortality. In order to eliminate potential donor-related confounders, we analysed the mortality of recipients, transplanted with organs procured from the same donor, in whom the initial RI values substantially differed. METHODS Doppler sonography was performed in 725 consecutive kidney graft recipients early after transplantation. We identified 133 pairs (266 patients) who received their kidney grafts from the same donor and their initial RI values differed by >0.1. RESULTS During 109 ± 37 months of follow-up after transplantation, 84 patients lost their graft and 29 died, 14 of them due to cardiovascular causes. Two groups of paired patients with higher RI and lower RI did not differ significantly with respect to their age, BMI, HLA mismatch and cold ischaemia time. There were more patients with diabetes in the higher RI group (14.3 versus 6.8%). Survival analysis revealed a higher mortality for cardiovascular (8.3 versus 2.3%, P = 0.02) and all causes (14.3 versus 7.5%, P = 0.06) among patients with higher initial RI values. In the Cox regression model, not including age, a higher RI value was a strong predictor of cardiovascular death (HR = 4.88), independent of previous cardiovascular episodes (HR = 6.78). Both these variables lost its significance as a predictors after inclusion of age in the regression model. CONCLUSION Increased intrarenal resistance index in the early posttransplant period may help to identify the recipients with increased cardiovascular risk.
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Affiliation(s)
- Aureliusz Kolonko
- Department of Nephrology, Transplantology and Internal Diseases, Medical University of Silesia, Katowice, Poland
| | - Jerzy Chudek
- Department of Nephrology, Transplantology and Internal Diseases, Medical University of Silesia, Katowice, Poland Department of Pathophysiology, Medical University of Silesia, Katowice, Poland
| | - Andrzej Więcek
- Department of Nephrology, Transplantology and Internal Diseases, Medical University of Silesia, Katowice, Poland
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20
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Hueper K, Gueler F, Bräsen JH, Gutberlet M, Jang MS, Lehner F, Richter N, Hanke N, Peperhove M, Martirosian P, Tewes S, Vo Chieu VD, Großhennig A, Haller H, Wacker F, Gwinner W, Hartung D. Functional MRI detects perfusion impairment in renal allografts with delayed graft function. Am J Physiol Renal Physiol 2015; 308:F1444-51. [DOI: 10.1152/ajprenal.00064.2015] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Accepted: 04/28/2015] [Indexed: 11/22/2022] Open
Abstract
Delayed graft function (DGF) after kidney transplantation is not uncommon, and it is associated with long-term allograft impairment. Our aim was to compare renal perfusion changes measured with noninvasive functional MRI in patients early after kidney transplantation to renal function and allograft histology in biopsy samples. Forty-six patients underwent MRI 4–11 days after transplantation. Contrast-free MRI renal perfusion images were acquired using an arterial spin labeling technique. Renal function was assessed by estimated glomerular filtration rate (eGFR), and renal biopsies were performed when indicated within 5 days of MRI. Twenty-six of 46 patients had DGF. Of these, nine patients had acute rejection (including borderline), and eight had other changes (e.g., tubular injury or glomerulosclerosis). Renal perfusion was significantly lower in the DGF group compared with the group with good allograft function (231 ± 15 vs. 331 ± 15 ml·min−1·100 g−1, P < 0.001). Living donor allografts exhibited significantly higher perfusion values compared with deceased donor allografts ( P < 0.001). Renal perfusion significantly correlated with eGFR ( r = 0.64, P < 0.001), resistance index ( r = −0.57, P < 0.001), and cold ischemia time ( r = −0.48, P < 0.01). Furthermore, renal perfusion impairment early after transplantation predicted inferior renal outcome and graft loss. In conclusion, noninvasive functional MRI detects renal perfusion impairment early after kidney transplantation in patients with DGF.
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Affiliation(s)
- Katja Hueper
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Faikah Gueler
- Department of Nephrology, Hannover Medical School, Hannover, Germany
| | | | - Marcel Gutberlet
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Mi-Sun Jang
- Department of Nephrology, Hannover Medical School, Hannover, Germany
| | - Frank Lehner
- Department of General, Abdominal and Transplant Surgery, Hannover Medical School, Hannover, Germany
| | - Nicolas Richter
- Department of General, Abdominal and Transplant Surgery, Hannover Medical School, Hannover, Germany
| | - Nils Hanke
- Department of Nephrology, Hannover Medical School, Hannover, Germany
| | - Matti Peperhove
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Petros Martirosian
- Section on Experimental Radiology, University of Tübingen, Tübingen, Germany; and
| | - Susanne Tewes
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Van Dai Vo Chieu
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Anika Großhennig
- Institute for Biostatistics, Hannover Medical School, Hannover, Germany
| | - Hermann Haller
- Department of Nephrology, Hannover Medical School, Hannover, Germany
| | - Frank Wacker
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Wilfried Gwinner
- Department of Nephrology, Hannover Medical School, Hannover, Germany
| | - Dagmar Hartung
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
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21
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Affiliation(s)
- Jörg Radermacher
- From the Department of Nephrology, Johannes Wesling Klinikum Minden, Minden (J.R.), and the Department of Nephrology, Hannover Medical School, Hannover (H.H.) - both in Germany
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22
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Heusch P, Wittsack HJ, Blondin D, Ljimani A, Nguyen-Quang M, Martirosian P, Zenginli H, Bilk P, Kröpil P, Heusner TA, Antoch G, Lanzman RS. Functional evaluation of transplanted kidneys using arterial spin labeling MRI. J Magn Reson Imaging 2013; 40:84-9. [PMID: 24123319 DOI: 10.1002/jmri.24336] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Accepted: 07/10/2013] [Indexed: 12/13/2022] Open
Abstract
PURPOSE To investigate non-contrast-enhanced arterial spin labeling (ASL) MRI for functional assessment of transplanted kidneys at 1.5 Tesla (T) and 3T. MATERIALS AND METHODS This study was approved by the local ethics committee, and written informed consent was obtained from all participants. Ninety eight renal allograft recipients (mean age, 51.5 ± 14.6 years) were prospectively included in this study. ASL MRI was performed at 1.5T (n = 65) and 3T (n = 33) using a single-slice flow-sensitive alternating inversion recovery true-fast imaging with steady-state precession (FAIR True-FISP) sequence in the paracoronal plane. ASL perfusion was regional analyzed for the renal cortex on parameter maps. ASL was compared between patients with good or moderate allograft function (Group a; estimated glomerular filtration rate [eGFR] > 30 mL/min/1.73 m(2)) and patients with heavily impaired allograft function (Group b; eGFR ≤ 30 mL/min/1.73 m(2)) and correlated to renal function as determined by eGFR. RESULTS ASL perfusion and eGFR were comparable at 1.5T (246.9 ± 66.8 mL/100 g/min and 41.9 ± 22.7 mL/min/1.73 m(2)) and 3T (236.5 ± 102.3 mL/100 g/min and 35.9 ± 22.9 mL/min/1.73 m(2)). ASL perfusion was significantly higher in group a (282.7 ± 60.8 mL/100 g/min) as compared to group b (178.2 ± 63.3 mL/100 g/min) (P < 0.0001). ASL perfusion values exhibited a significant correlation with renal function as determined by eGFR (r = 0.59; P < 0.0001). CONCLUSION Cortical ASL perfusion values differ between patients with good or moderate allograft function and poor allograft function and correlate significantly with allograft function. Our results highlight the potential of ASL MRI for functional evaluation of renal allografts.
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Affiliation(s)
- Philipp Heusch
- University Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, Dusseldorf, Germany
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23
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Kolonko A, Chudek J, Kujawa-Szewieczek A, Wiȩcek A. Nutritional Status and Intrarenal Resistive Indices After Kidney Transplantation. Transplant Proc 2013; 45:1625-9. [PMID: 23726635 DOI: 10.1016/j.transproceed.2012.11.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2012] [Accepted: 11/19/2012] [Indexed: 12/17/2022]
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24
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Kolonko A, Wiecek A. The closer the shield, the higher the score: timing of resistance index measurement and its prognostic impact in kidney transplant recipients. Nephrol Dial Transplant 2012; 27:3677-9. [PMID: 22879392 DOI: 10.1093/ndt/gfs340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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