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Stigler J, Tiefenthaler M. Value and limitations of sonography in kidney transplant recipients with special attention to the resistive index - An update. FRONTIERS IN NEPHROLOGY 2022; 2:997839. [PMID: 37675004 PMCID: PMC10479591 DOI: 10.3389/fneph.2022.997839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 08/15/2022] [Indexed: 09/08/2023]
Abstract
Kidney transplantation has become the standard treatment for end-stage renal disease. Even though the success rates are high, early and late post-transplant complications remain a major clinical problem due to the risk of graft failure. Therefore, it is of highest interest to early diagnose post-transplant complications. Ultrasound with color coded Duplex analysis plays a crucial role in imaging mechanical and vascular complications. In this article, we give an update of the visualizable complications in kidney transplant recipients and discuss the value of resistive index (RI) measurement with its limitations in allograft rejection.
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Affiliation(s)
| | - Martin Tiefenthaler
- Department of Internal Medicine IV (Nephrology and Hypertension), Medical University Innsbruck, Innsbruck, Austria
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Sugi MD, Joshi G, Maddu KK, Dahiya N, Menias CO. Imaging of Renal Transplant Complications throughout the Life of the Allograft: Comprehensive Multimodality Review. Radiographics 2020; 39:1327-1355. [PMID: 31498742 DOI: 10.1148/rg.2019190096] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The kidney is the most commonly transplanted solid organ. Advances in surgical techniques, immunosuppression regimens, surveillance imaging, and histopathologic diagnosis of rejection have allowed prolonged graft survival times. However, the demand for kidneys continues to outgrow the available supply, and there are efforts to increase use of donor kidneys with moderate- or high-risk profiles. This highlights the importance of evaluating the renal transplant patient in the context of both donor and recipient risk factors. Radiologists play an integral role within the multidisciplinary team in care of the transplant patient at every stage of the transplant process. In the immediate postoperative period, duplex US is the modality of choice for evaluating the renal allograft. It is useful for establishing a baseline examination for comparison at future surveillance imaging. In the setting of allograft dysfunction, advanced imaging techniques including MRI or contrast-enhanced US may be useful for providing a more specific diagnosis and excluding nonrejection causes of renal dysfunction. When a pathologic diagnosis is deemed necessary to guide therapy, US-guided biopsy is a relatively low-risk, safe procedure. The range of complications of renal transplantation can be organized temporally in relation to the time since surgery and/or according to disease categories, including immunologic (rejection), surgical or iatrogenic, vascular, urinary, infectious, and neoplastic complications. The unique heterotopic location of the renal allograft in the iliac fossa predisposes it to a specific set of complications. As imaging features of infection or malignancy may be nonspecific, awareness of the patient's risk profile and time since transplantation can be used to assign the probability of a certain diagnosis and thus guide more specific diagnostic workup. It is critical to understand variations in vascular anatomy, surgical technique, and independent donor and recipient risk factors to make an accurate diagnosis and initiate appropriate treatment.©RSNA, 2019.
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Affiliation(s)
- Mark D Sugi
- From the Department of Radiology, Mayo Clinic, Scottsdale, Ariz (M.D.S., N.D., C.O.M.); and Departments of Radiology and Imaging Sciences (G.J., K.K.M.) and Emergency Medicine (G.J., K.K.M.), Emory University School of Medicine, Atlanta, Ga
| | - Gayatri Joshi
- From the Department of Radiology, Mayo Clinic, Scottsdale, Ariz (M.D.S., N.D., C.O.M.); and Departments of Radiology and Imaging Sciences (G.J., K.K.M.) and Emergency Medicine (G.J., K.K.M.), Emory University School of Medicine, Atlanta, Ga
| | - Kiran K Maddu
- From the Department of Radiology, Mayo Clinic, Scottsdale, Ariz (M.D.S., N.D., C.O.M.); and Departments of Radiology and Imaging Sciences (G.J., K.K.M.) and Emergency Medicine (G.J., K.K.M.), Emory University School of Medicine, Atlanta, Ga
| | - Nirvikar Dahiya
- From the Department of Radiology, Mayo Clinic, Scottsdale, Ariz (M.D.S., N.D., C.O.M.); and Departments of Radiology and Imaging Sciences (G.J., K.K.M.) and Emergency Medicine (G.J., K.K.M.), Emory University School of Medicine, Atlanta, Ga
| | - Christine O Menias
- From the Department of Radiology, Mayo Clinic, Scottsdale, Ariz (M.D.S., N.D., C.O.M.); and Departments of Radiology and Imaging Sciences (G.J., K.K.M.) and Emergency Medicine (G.J., K.K.M.), Emory University School of Medicine, Atlanta, Ga
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Abstract
In patients with end-stage renal disease, the treatment of choice for most patients is renal transplantation. Complications that occur after kidney transplant can be broadly divided into vascular and non-vascular categories. Non-vascular complications can further be divided into surgical and medical categories. When evaluating renal transplant imaging, it is helpful to consider the occurrence of complications in a timeline from time of surgery. Ultrasound is often the first modality used for evaluation of renal transplants particularly in the early postoperative period. Contrast-enhanced ultrasound can be a helpful adjunct in evaluating certain complications such as hematoma, rejection, and infection. Computed tomography (CT) is also helpful in accurately diagnosing complications. Surgical complications include perinephric fluid collections (hematoma, urinoma from urine leak, abscess, and lymphocele), urinary obstruction, and incisional fluid collections and hernias. One major category of medical complications that affect the renal parenchyma includes rejection (hyperacute, acute, and chronic), delayed graft function, acute tubular necrosis (ATN), and nephrotoxicity. Infection, renal calculi, and neoplasms such as post-transplant lymphoproliferative disease are medical complications that occur after renal transplantation. It is important for radiologists to be aware of the ultrasound and CT findings of the surgical and medical complications after renal transplant for prompt identification and treatment.
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Affiliation(s)
- Nancy Kim
- Department of Radiology, MedStar Georgetown University Hospital, CCC Building, Ground Floor, 3800 Reservoir Road NW, Washington, DC, 20007, USA.
| | - Roxanna Juarez
- Department of Radiology, MedStar Georgetown University Hospital, CCC Building, Ground Floor, 3800 Reservoir Road NW, Washington, DC, 20007, USA
| | - Angela D Levy
- Department of Radiology, MedStar Georgetown University Hospital, CCC Building, Ground Floor, 3800 Reservoir Road NW, Washington, DC, 20007, USA
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Inci MF, Ozkan F, See TC, Tatli S. Renal Transplant Complications: Diagnostic and Therapeutic Role of Radiology. Can Assoc Radiol J 2014; 65:242-52. [DOI: 10.1016/j.carj.2013.06.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2013] [Revised: 06/05/2013] [Accepted: 06/21/2013] [Indexed: 02/08/2023] Open
Abstract
Kidney was the first and is the most frequently transplanted organ. Despite improved surgical techniques and transplantation technology, complications do occur and, if left untreated, may lead to catastrophic consequences. Renal transplantation complications may be vascular (eg, renal artery and vein stenosis and thrombosis, arteriovenous fistula, and pseudoaneurysms); urologic (eg, urinary obstruction and leak, and peritransplantation fluid collections, including hematoma, seroma, lymphocele, and abscess formation); and nephrogenic, including acute tubular necrosis, graft rejection, chronic allograft nephropathy, and neoplasm. Early diagnosis and treatment of these complications are paramount to prevent graft failure and other significant morbidities to the patients. Radiology plays a pivotal role in the diagnosis and treatment of these complications, with minimally invasive percutaneous techniques. In this article, we reviewed renal transplantation anatomy, a wide range of complications that may occur after renal transplantation surgery, typical imaging appearances of the complications on varies imaging modalities, and percutaneous interventional techniques that are used in their treatment.
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Affiliation(s)
- Mehmet Fatih Inci
- Department of Radiology, Sütçü İmam University Medical School, Kahramanmaraş, Turkey
| | - Fuat Ozkan
- Department of Radiology, Sütçü İmam University Medical School, Kahramanmaraş, Turkey
| | - Teik Choon See
- Department of Radiology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Servet Tatli
- Division of Abdominal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Eisenberger U, Thoeny HC, Binser T, Gugger M, Frey FJ, Boesch C, Vermathen P. Evaluation of renal allograft function early after transplantation with diffusion-weighted MR imaging. Eur Radiol 2009; 20:1374-83. [PMID: 20013274 DOI: 10.1007/s00330-009-1679-9] [Citation(s) in RCA: 107] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2009] [Revised: 08/31/2009] [Accepted: 09/17/2009] [Indexed: 01/01/2023]
Abstract
AIMS To determine the inter-patient variability of apparent diffusion coefficients (ADC) and concurrent micro-circulation contributions from diffusion-weighted MR imaging (DW-MRI) in renal allografts early after transplantation, and to obtain initial information on whether these measures are altered in histologically proven acute allograft rejection (AR). METHODS DW-MRI was performed in 15 renal allograft recipients 5-19 days after transplantation. Four patients presented with AR and one with acute tubular necrosis (ATN). Total ADC (ADC(T)) was determined, which includes diffusion and micro-circulation contributions. Furthermore, diffusion and micro-circulation contributions were separated, yielding the "perfusion fraction" (F(P)), and "perfusion-free" diffusion (ADC(D)). RESULTS Diffusion parameters in the ten allografts with stable function early after transplantation demonstrated low variabilities. Values for ADC(T) and ADC(D) were (x10(-5) mm(2)/s) 228 +/- 14 and 203 +/- 9, respectively, in cortex and 226 +/- 16 and 199 +/- 9, respectively, in medulla. F(P) values were 18 +/- 5% in cortex and 19 +/- 5% in medulla. F(P) values were strongly reduced to less than 12% in cortex and medulla of renal transplants with AR and ATN. F(P) values correlated with creatinine clearance. CONCLUSION DW-MRI allows reliable determination of diffusion and micro-circulation contributions in renal allografts shortly after transplantation; deviations in AR indicate potential clinical utility of this method to non-invasively monitor derangements in renal allografts.
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Affiliation(s)
- Ute Eisenberger
- Department of Nephrology and Hypertension, University Hospital of Bern, Bern, Switzerland
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Krejčí K, Zadražil J, Tichý T, Al-Jabry S, Horčička V, Štrebl P, Bachleda P. Sonographic findings in borderline changes and subclinical acute renal allograft rejection. Eur J Radiol 2009; 71:288-95. [DOI: 10.1016/j.ejrad.2008.04.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2007] [Revised: 02/01/2008] [Accepted: 04/21/2008] [Indexed: 02/05/2023]
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Wang HK, Chou YH, Yang AH, Chiou SY, Chiou HJ, Wu TH, Loong CC, Chang CY. Evaluation of cortical perfusion in renal transplants: application of quantified power Doppler ultrasonography. Transplant Proc 2008; 40:2330-2. [PMID: 18790226 DOI: 10.1016/j.transproceed.2008.06.046] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Perfusion of renal transplants may be altered by various pathological conditions. This study assessed cortical perfusion of renal transplants during acute rejection episodes using power Doppler quantification. Forty-eight renal transplant patients with clinical indications for biopsy were included in this study. Power Doppler ultrasonography (US) of these renal transplants was performed prior to biopsy. Power Doppler image intensity in the proximal outer cortex of renal transplants was quantified by image analysis software. The results of power Doppler quantification were compared with the clinical data and histological findings. Biopsies were classified into three groups based on Banff diagnostic categories: group 1 (no acute rejection; 26 patients), group 2 (acute cell-mediated rejection alone; 12 patients), and group 3 (acute antibody-mediated rejection with/or without acute cell-mediated rejection; 10 patients). The power Doppler intensity of the outer renal cortex was 1.98 +/- 1.50 dB for group 1, 1.38 +/- 0.86 dB for group 2, and 0.81 +/- 0.66 dB for group 3. Statistically, there was a significant difference between group 1 and group 3 (1.98 vs 0.81 dB, P = .01) but not between group 1 and group 2 (1.98 vs 1.38 dB, P = .34). In conclusion, the status of cortical perfusion of renal transplants can be determined noninvasively by quantified power Doppler US. Accordingly, acute antibody-mediated rejection is associated with significantly decreased cortical perfusion, which, we propose, is due to this distinct pathological process.
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Affiliation(s)
- H-K Wang
- Department of Radiology, Taipei Veterans General Hospital and School of Medicine, National Yang-Ming University, Taipei, Taiwan.
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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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Scholbach T, Girelli E, Scholbach J. Dynamic Tissue Perfusion Measurement: A Novel Tool in Follow-Up of Renal Transplants. Transplantation 2005; 79:1711-6. [PMID: 15973173 DOI: 10.1097/01.tp.0000164145.89275.02] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The authors applied the novel method of noninvasive dynamic color Doppler sonographic parenchymal perfusion measurement to renal transplants. METHODS Color Doppler sonographic videos of renal transplants from 38 renal transplant recipients were recorded under defined conditions. Specific tissue perfusion was calculated as mean flow velocity encoded by color Doppler signals of a region of interest during one full heart cycle. RESULTS The authors could demonstrate significant differences of central versus peripheral cortical perfusion intensity (1.36 vs. 0.60 cm/sec) and a significant loss of perfusion intensity in the posttransplantation period in the peripheral cortex from 1.06 cm/sec in the first year to a minimum of 0.39 cm/sec in the 3- to 5-year interval, with stronger perfusion in longer surviving transplants: 0.71 cm/sec more than 9 years after transplantation. In the central cortex, a similar but less pronounced pattern could be demonstrated. A significant drop of parenchymal perfusion was found in patients with elevated serum creatinine (1.36 cm/sec in cases with normal and 0.82 cm/sec in those with elevated creatinine at the proximal cortical level). The perfusion ratio of the central 50% and the peripheral 50% shows marked changes over time: in the first year, the ratio was 2.99, climbing to 5.56 at the 3- to 5-year interval and declining later on. CONCLUSIONS Cortical tissue perfusion in renal transplants was quantified noninvasively from color Doppler signal data in an easily accomplishable manner. Renal transplants showed a marked decline in tissue perfusion after transplantation. Perfusion is significantly lower in transplant function loss with elevated serum creatinine.
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Affiliation(s)
- Thomas Scholbach
- St. Georg Municipal Children's Hospital, Delitzscher Strasse 141, D-04129 Leipzig, Germany.
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Souza SALD, Martins FPP, Gonçalves RT, Pontes DS, Carvalho ACP, Fonseca LMBD, Gutfilen B. Avaliação de transplantes renais utilizando-se 99mTc-leucócitos mononucleares. Radiol Bras 2004. [DOI: 10.1590/s0100-39842004000100005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
A rejeição aguda do enxerto renal deve ser diagnosticada precocemente, uma vez que a reversibilidade da rejeição está relacionada com a rapidez na qual o tratamento é iniciado. Os objetivos deste estudo foram: 1) estabelecer um método quantitativo para avaliação da rejeição e necrose tubular aguda (NTA) do rim transplantado; 2) determinar o papel em potencial da cintilografia com leucócitos mononucleares marcados com tecnécio-99m no diagnóstico precoce da rejeição do rim transplantado e no diagnóstico diferencial da NTA. Cento e sessenta estudos cintilográficos foram realizados no primeiro e no quinto dia pós-operatório em 80 pacientes transplantados. Células autólogas foram utilizadas para marcação. Imagens foram obtidas 30 minutos, 3 horas e 24 horas após injeção de 444 MBq (12 mCi) das células marcadas. Houve captação anormal das células marcadas em 27 de 31 casos de rejeição e em seis de oito casos de NTA. Os resultados foram comparados com a clínica de cada paciente. Ultra-sonografias com Doppler detectaram 18 de 31 casos de rejeição. A sensibilidade e a especificidade para rejeição foram, respectivamente, de 87,1% e 100% para a cintilografia e 58,1% e 100% para a ultra-sonografia. Foram realizadas biópsias em oito pacientes, que mostraram sete rejeições e uma NTA. Os resultados sugerem que a cintilografia com leucócitos mononucleares marcados com tecnécio-99m pode ser útil no diagnóstico de rejeição e diagnóstico diferencial de NTA.
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Nankivell BJ, Chapman JR, Gruenewald SM. Detection of chronic allograft nephropathy by quantitative doppler imaging. Transplantation 2002; 74:90-6. [PMID: 12134105 DOI: 10.1097/00007890-200207150-00016] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Chronic allograft nephropathy (CAN) is the major cause of graft loss, and early detection is desirable to avoid irreversible graft damage. We have evaluated a new technique of color Doppler quantification using Cineloop (Philips Medical Systems, Bothell, WA) imaging for noninvasive diagnosis of CAN. METHODS Provisional normal ranges were defined by pilot study (n=13) and prospectively tested in stable recipients in whom CAN was independently quantified by contemporaneous histology (n=67), using the Banff schema. RESULTS The maximal fractional area (MFA, systolic color pixels/total area) was 28.7+/-9.7% in normal subjects and reduced to 18.8+/-8.0% in grade 1 and 12.5+/-6.4% in grade 2 CAN (both P<0.001). The minimum color fractional area was reduced from 10.3+/-5.3% in normal subjects to 3.1+/-2.6% in grade 2 CAN (P<0.001), but was less useful. Distance from peripheral color pixels to capsule increased in CAN grade 2 versus 0 (6.0+/-1.6 vs. 3.9+/-1.0 mm, respectively; P<0.001). Calcineurin inhibitor nephrotoxicity reduced MFA (18.0+/-9.3 vs. 26.9+/-10.7%; P<0.001) and other dynamic measurements. Parenchymal damage exerted minimal effect on resistance index, mean variance, and peak Doppler velocity. MFA (cutoff<17.3%) can diagnose CAN (sensitivity 69%, specificity 88%, positive predictive value 86%) and severe CAN (sensitivity 87%, specificity 71%, negative predictive value 95%). Distance to capsule >5 mm was less sensitive (49%) but more specific (91% alone, and 97% combined with MFA). CONCLUSIONS In conclusion, quantitative Doppler ultrasound can reliably detect CAN and, although imperfect at correctly grading, allows recognition of significant tubulointerstitial damage for initiation of a confirmatory needle core biopsy.
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Affiliation(s)
- Brian J Nankivell
- Department of Renal Medicine, University of Sydney, Westmead Hospital, Australia
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Gaschen L, Schuurman HJ. Contribution of power Doppler sonography to the detection of renal allograft rejection in the cynomolgus monkey. Invest Radiol 2001; 36:335-40. [PMID: 11410754 DOI: 10.1097/00004424-200106000-00006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
RATIONALE AND OBJECTIVES To evaluate whether a change in the power Doppler (PD) flow signals produced by the renal cortical interlobular vasculature of allografts in cynomolgus monkey transplant models is useful for the detection of cellular rejection and vasculopathies. METHODS Seventy-three monkeys with life-supporting allografts (bilateral native kidney nephrectomy) and 20 monkeys with allografts implanted with only unilateral native kidney nephrectomy were examined with ultrasound that included an examination with PD. Each graft received a PD score of 3 (normal cortical blush), 2 (reduced flow, no blush), or 1 (absence of cortical flow), and the results were compared with histology either from ultrasound-guided biopsy or at necropsy. RESULTS One hundred seventy-one allograft examinations (histological and PD) were compared. Histologically normal grafts were statistically more likely to have normal PD findings than were those with reduced flow or absent flow. Allografts with reduced flow had statistically more severe cellular rejection than those with normal flow. Also, vasculopathies were present in all three PD groups. CONCLUSIONS Reduced renal cortical flow in the cynomolgus monkey renal allograft indicates that more severe degrees of cellular rejection are present compared with allografts with normal flow. Overlap in the histological diagnoses of allografts with normal and reduced flow exists, and the finding of reduced flow with PD may be prognostically important and indicates the need for tissue sampling.
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Affiliation(s)
- L Gaschen
- Novartis Pharma AG, Transplantation Research, Basel, Switzerland.
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Gaschen L, Schuurman HJ. Renal allograft vasculopathy: ultrasound findings in a non-human primate model of chronic rejection. Br J Radiol 2001; 74:411-9. [PMID: 11388989 DOI: 10.1259/bjr.74.881.740411] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The purpose was to determine whether decreased cortical flow detected with power Doppler (PD) ultrasound in renal allografts in cynomolgus monkeys marks the presence or onset of chronic renal allograft vasculopathy. The 2D grey scale and PD ultrasound findings of 24 consecutively implanted non-life-supporting renal allografts in cynomolgus monkeys that underwent either 24 h (n=15) or 48 h (n=9) cold ischaemia times were recorded and compared with the results of histology performed every 2 weeks post-operatively. 13 allografts developed vasculopathies, 10 of which had PD scores equal to 1 (severe reduction of cortical flow). A PD score of 1 occurred in only one instance in the group of allografts without vasculopathies and this was due to necrosis. Allografts without vasculopathies otherwise had either PD scores of 3 (normal flow; n=2) or 2 (reduced flow; n=4). Allografts subjected to 48 h cold ischaemia times were smaller than those with 24 h cold ischaemia times (significant at weeks 5-11, p<0.05), but a reduction in graft size associated with vasculopathies occurred infrequently. In conclusion, the finding of reduced renal cortical flow detected by PD ultrasound during serial examination of non-life-supporting renal allografts is highly supportive of a diagnosis of graft vasculopathy due to arteriolar intimal proliferation, and illustrates an excellent method of monitoring changes in cortical perfusion in allografts in animal models. The combination of findings of reduced or absent cortical flow together with severe graft enlargement is highly suggestive of the presence of not only vasculopathies but also tissue damage and degeneration.
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Affiliation(s)
- L Gaschen
- Novartis Pharma AG, Transplantation Research, WSJ 386.526, S.386.526 Kohlenstrasse, 4002 Basel, Switzerland
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