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Rowland R, Ponticorvo A, Jarrin Lopez A, Li S, Li X, Ichii H, Durkin AJ. Monitoring kidney optical properties during cold storage preservation with spatial frequency domain imaging. JOURNAL OF BIOMEDICAL OPTICS 2019; 24:1-7. [PMID: 31777223 PMCID: PMC6882458 DOI: 10.1117/1.jbo.24.11.116003] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 11/11/2019] [Indexed: 05/18/2023]
Abstract
Transplantation of kidneys results in delayed graft function in as many as 40% of cases. During the organ transplantation process, donor kidneys undergo a period of cold ischemic time (CIT), where the organ is preserved with a cold storage solution to maintain tissue viability. Some complications observed after grafting may be due to damage sustained to the kidney during CIT. However, the effects due to this damage are not apparent until well after transplant surgery has concluded. To this end, we have used spatial frequency domain imaging (SFDI) to measure spatially resolved optical properties of porcine kidneys over the course of 80-h CIT. During this time, we observed an increase in both reduced scattering (μ s& ' ) and absorption (μa) coefficients. The measured scattering b parameter increased until 24 h of CIT, then returned toward baseline during the remaining duration of the imaging sequence. These results show that the optical properties of kidney tissue change with increasing CIT and suggest that continued investigation into the application of SFDI to kidneys under CIT may lead to the development of a noninvasive method for assessing graft viability.
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Affiliation(s)
- Rebecca Rowland
- University of California, Irvine, Beckman Laser Institute and Medical Clinic, Irvine, California, United States
| | - Adrien Ponticorvo
- University of California, Irvine, Beckman Laser Institute and Medical Clinic, Irvine, California, United States
| | - Alberto Jarrin Lopez
- University of California, Irvine, Department of Surgery, UC Irvine Division of Transplantation, Orange, California, United States
| | - Shiri Li
- University of California, Irvine, Department of Surgery, UC Irvine Division of Transplantation, Orange, California, United States
| | - Xiaodong Li
- UC Irvine Health Douglas Hospital, Department of Pathology, Orange, California, United States
| | - Hirohito Ichii
- University of California, Irvine, Department of Surgery, UC Irvine Division of Transplantation, Orange, California, United States
| | - Anthony J. Durkin
- University of California, Irvine, Beckman Laser Institute and Medical Clinic, Irvine, California, United States
- University of California, Irvine, Department of Biomedical Engineering, Irvine, California, United States
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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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Sotrastaurin (AEB071) alone and in combination with cyclosporine A prolongs survival times of non-human primate recipients of life-supporting kidney allografts. Transplantation 2012; 93:156-64. [PMID: 22179400 DOI: 10.1097/tp.0b013e31823cf92f] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Sotrastaurin (STN), a novel oral protein kinase C inhibitor that inhibits early T-cell activation, was assessed in non-human primate recipients of life-supporting kidney allografts. METHODS Cynomolgus monkey recipients of life-supporting kidney allografts were treated orally with STN alone or in combination with cyclosporine A (CsA). RESULTS STN monotherapy at 50 mg/kg once daily prolonged recipient survival times to the predefined endpoint of 29 days (n=2); when given at 25 mg/kg twice daily, the median survival time (MST) was 27 days (n=4). Neither once-daily monotherapy of STN 20 mg/kg nor CsA 20 mg/kg was effective (MST 6 days [n=2] and 7 days [n=5], respectively). In combination, however, STN 20 mg/kg and CsA 20 mg/kg prolonged MST to more than 100 days (n=5). By combining lower once-daily doses of STN (7 or 2 mg/kg) with CsA (20 mg/kg), MST was more than 100 (n=3) and 22 days (n=2), respectively. Neither in single-dose pharmacokinetic studies nor the transplant recipients were STN or CsA blood levels for combined treatment greater than when either drug was administered alone. STN blood levels in transplant recipients during combination therapy were dose related (20 mg/kg, 30-182 ng/mL; 7 mg/kg, 7-41 ng/mL; and 2 mg/kg, 3-5 ng/mL). STN at a daily dose of up to 20 mg/kg was relatively well tolerated. CONCLUSIONS STN prolonged survival times of non-human primate kidney allograft recipients both as monotherapy and most effectively in combination with CsA. Pharmacokinetic interactions were not responsible for the potentiation of immunosuppressive efficacy by coadministering STN and CsA.
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Role of resistive index measurement in diagnosis of acute rejection episodes following successful kidney transplantation. Transplant Proc 2010; 41:2805-7. [PMID: 19765440 DOI: 10.1016/j.transproceed.2009.07.050] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE This study was performed to evaluate the role of resistive index (RI) in the diagnosis of rejection episodes following successful kidney transplantation. MATERIALS AND METHODS One hundred and one unrelated living first kidney allograft adult recipients (75 males and 26 females) of overall mean age of 39 years were enrolled and prospectively followed for 6 months. The measurement of RI by Doppler ultrasonography was performed in all patients on days 3 and 7 as well as at months 1, 3, and 6 in addition to when there was graft dysfunction. We determined serum creatinine and cyclosporine levels. RESULTS Twenty-seven patients (26.7%) experienced 33 acute rejection episodes during the follow-up. There were significant differences between mean RI among patients with normal function vs rejection: 0.606 +/- 0.065 vs 0.866 +/- 0.083 (P < .05), respectively. Overall, elevated levels of cyclosporine, ischemic acute tubular necrosis (ATN), and renal artery thrombosis were observed in 8, 5, and 3 patients, respectively. No association was observed between these factors and RI. CONCLUSIONS RI was significantly higher in patients with acute rejection episodes. It had no association with ATN or cyclosporine toxicity. Hence, RI may be useful to diagnose acute renal allograft rejection following renal transplantation.
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SCHMIEDT CHADW, DELANEY FERNA, McANULTY JONATHANF. ULTRASONOGRAPHIC DETERMINATION OF RESISTIVE INDEX AND GRAFT SIZE FOR EVALUATING CLINICAL FELINE RENAL ALLOGRAFTS. Vet Radiol Ultrasound 2008; 49:73-80. [DOI: 10.1111/j.1740-8261.2007.00321.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Nezami N, Tarzamni M, Argani H, Nourifar M. Doppler Ultrasonographic Indices After Renal Transplantation as Renal Function Predictors. Transplant Proc 2008; 40:94-9. [DOI: 10.1016/j.transproceed.2007.11.036] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Tarzamni MK, Argani H, Nurifar M, Nezami N. Vascular complication and Doppler ultrasonographic finding after renal transplantation. Transplant Proc 2007; 39:1098-102. [PMID: 17524902 DOI: 10.1016/j.transproceed.2007.02.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVES Vascular complications are common after renal transplantation. In this study we correlated Doppler sonographic indices and transplant kidney function. METHODS We reviewed data on 244 renal transplant patients. Doppler ultrasonographic evaluation was performed during the first 2 weeks after renal transplantation. We determined resistive index (RI) and pulsatility index (PI) in the interlobar arteries and thrombosis of renal and lower limb veins. Serum creatinine (Cr) and cyclosporine levels were evaluated prior to sonographic assessment. RESULTS The mean age of the 142 male and 102 female patients was 36.31 +/- 3.30 years. Prevalence of real artery stenosis was 9.5%. In these patients the mean serum Cr level (2.21 +/- 1.83 mg/dL) was significantly higher than among patients with patent renovascular tributary (1.49 +/- 1.00 mg/dL; P=.03). RI and PI were also significantly correlated with serum Cr(P=.05 and .001, respectively). There was no relationship between cyclosporine level or panel-reactive antibody with RI and PI. Retransplant patients showed higher RI than first renal allograft recipients (0.72 +/- 0.16 vs 0.63 +/- 0.11; P=.006). Serum Cr level was higher among renal allograft recipients with Doppler evidence of thrombosis of the lower limb veins (3.1 +/- 0.98 mg/dL versus 1.56 +/- 1.13 mg/dL; P=.04). CONCLUSIONS RI and PI are two valuable Doppler ultrasonographic markers to determine renal allograft function and related vascular complications.
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Affiliation(s)
- M K Tarzamni
- Department of Radiology, Imam Hospital, Tabriz University of Medical Science, East Azerbaijan, Iran.
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Scholbach T, Girelli E, Scholbach J. Tissue Pulsatility Index: A New Parameter to Evaluate Renal Transplant Perfusion. Transplantation 2006; 81:751-5. [PMID: 16534478 DOI: 10.1097/01.tp.0000201928.04266.d2] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND : Chronic allograft nephropathy (CAN) is characterized by loss of parenchymal perfusion. We applied therefore the novel parameter Tissue Pulsatility Index (TPI) to quantify transplant perfusion in the long-term surveillance of renal transplants. METHODS : Color Doppler sonographic videos of renal transplants from 38 renal transplant recipients were recorded under defined conditions. TPI was calculated as ratio of the difference of mean systolic and diastolic velocities of the entire region and the average velocity. RESULTS : TPI was significantly different between the proximal and distal cortical layers (1.12 vs. 1.56, respectively P=0.000). In patients with elevated creatinine as a measure of compromised function, significantly (P=0.016) higher values (TPI=1.70) were found at distal cortical level compared to patients with normal creatinine (TPI=1.34). After transplantation, TPI rises significantly: 1.10 in 0-1 years vs. 1.41 in 1-2.9 years, P=0.002; 1.10 in 0-1 years vs. 1.37 in 3-4.9 years, P=0.000; 1.10 in 0-1 years vs. 1.31 in 7-8.9 years, P=0.049). TPI declines later on in our population to significantly lowered values in the group more than 9 years after transplantation (1.10 in 0-1 years vs. 0.94 in >9 years, P=0.044). CONCLUSION : With the novel TPI, we could demonstrate significant differences between proximal and distal cortical perfusion, between compromised and well-functioning transplants, and could observe significant changes of transplant perfusion at various points at the posttransplantation time scale.
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Affiliation(s)
- Thomas Scholbach
- Kinderklinik am Städtischen Klinikum "St. Georg," Leipzig, Germany.
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Raiteri M, Ferraresso M, Pozzoli E, Beretta C, Pasciucco A, Carini M, Berardinelli L. Value of Intraoperative Resistive Index in Kidney Transplant. Transplant Proc 2005; 37:2472-3. [PMID: 16182713 DOI: 10.1016/j.transproceed.2005.06.075] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The value of the resistive index (RI) obtained by echo color doppler evaluation of the transplanted kidney is still not well established. Many authors consider the RI to be nonspecific sign of rejection, acute tubular necrosis, or urinary tract obstruction, but its specificity remains low. In this paper, we report our experience with RI determinations in 34 consecutive kidney transplants at different times namely: perioperatively, at 24 hours, at 3 days, at 6 and at 9 days posttransplant. In all patients intraoperative RI was normal. RI increased significantly after transplantation in 10 patients who eventually developed a complication: delayed function, acute rejection, and spontaneous kidney ruptures. This increment from the baseline value was already significant at 24 hours after the kidney transplant, indicating a possible posttransplant complication (0.62 +/- 0.07 vs 0.76 +/- 0.04; P = .0004). We conclude that the value of RI in the early posttransplant phase should be considered an important aid for the early diagnosis of posttransplant complications.
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Affiliation(s)
- M Raiteri
- U.O. Vascular Surgery and Kidney Transplantation, Ospedale Maggiore-Policlinico Milan, Milan, Italy.
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Kim K, Kim SH, Yang CW, Li C, Chung YA, Lee SY, Sohn HS, Chung SK. Differentiation between acute cyclosporine nephrotoxicity and acute tubular necrosis using enalaprilat renal scintigraphy in rats. Invest Radiol 2003; 38:473-81. [PMID: 12874513 DOI: 10.1097/01.rli.0000065696.41011.ce] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
RATIONALE AND OBJECTIVES Acute cyclosporine (CsA) nephrotoxicity cannot be easily differentiated from other renal parenchymal complications, such as acute tubular necrosis (ATN), that cause renal function impairment at the early posttransplantation period. The purpose of this study was to differentiate acute CsA nephrotoxicity from ATN using enalaprilat renal scintigraphy in rats. METHODS Twenty-six rats were divided into 4 experimental groups: CsA group, who were treated with CsA (50 mg/kg/d) for 2 days; ATN group, who received clamping of both renal arteries for 45 minutes; vehicle group, who were treated with olive oil (1 mL/kg/d) for 2 days; and sham-operated group, who received the same surgical procedure as ATN group without clamping of renal arteries. The baseline study was performed with 300 microCi of technetium-99m diethylenetriaminepentaacetic acid and enalaprilat scintigraphy with 2 mCi of technetium-99m diethylenetriaminepentaacetic acid 5 minutes after intravenous enalaprilat injection (30 microg/kg). The changes of renogram grade and the renal function indices such as T(max), T(1/2), residual cortical activity, and mean transit time between 2 studies were analyzed. Immediately after renal scintigraphy, blood urea nitrogen and serum creatinine levels were measured and renal tissues stained by periodic acid Schiff reaction were examined in each group. RESULTS Blood urea nitrogen and serum creatinine levels in the CsA and ATN groups were higher than their control groups (P < 0.05). Histologic study revealed severe ischemic necrosis of tubular epithelium in ATN group, but the other groups remained with essentially normal morphology. After enalaprilat injection, renal function indices became improved in CsA group, whereas they deteriorated in ATN group. The renogram grade was decreased in CsA group and increased or unchanged in ATN group after enalaprilat injection. The T(max), residual cortical activity, and mean transit time ratio were statistically different between the 2 groups on enalaprilat study (P < 0.05). CONCLUSIONS These results suggest that enalaprilat renal scintigraphy could be used clinically in differentiating acute CsA nephrotoxicity from ATN after renal transplantation.
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Affiliation(s)
- Kijun Kim
- Department of Radiology, The Catholic University of Korea, Seoul, Korea
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