Frontiers in TransplantationKidney transplantationContrast-Enhanced Ultrasonography in the Early Period After Kidney Transplantation Predicts Long-Term Allograft Function
Section snippets
Patients
This prospective, explorative single-center clinical trial all patients >18 years who underwent kidney transplantation at University Hospital Heidelberg between January 2011 and September 2011 were eligible for the study. The local ethical committee approved the study protocol (S-497/2010), and all patients gave written informed consent. Exclusion criteria were defined as renal artery stenosis or arteriovenous fistula of the allograft, screened by CDUS, the presence of aortal synthetic vascular
Patients
A total of 80 patients were eligible for the study. Seventy-one patients met inclusion criteria and were enrolled. Only 2 patients (2.94%) lost their graft during follow-up. Both patients suffered from refractory acute cellular rejection in the first month after kidney transplantation. There was no association to RRI; 1 patient had an RRI > 0.7 and 1 patient < 0.7, and RBF (1 patient > 12 dB/s, 1 patient < 12 dB/s), respectively. One patient died during the follow-up at month 10 after kidney
Discussion
The salient finding of the study is that RRI is not associated with characteristics of the kidney transplant, whereas RBF evaluated by CES is a prognostic marker for kidney allograft function after 12 months and associated with histologic findings of the engraftment biopsy, therefore reflecting characteristics of the kidney allograft itself.
In an earlier prospective study by Radermacher et al [3], it was postulated that an RRI of >0.8 was a prognostic marker of allograft and patient survival.
Acknowledgments
The authors thank Peter Nawroth, who helped to fund the study via a research grant from the Hopp-Stiftung.
References (31)
- et al.
Renal Doppler resistance indices are associated with systemic atherosclerosis in kidney transplant recipients
Kidney Int
(2005) - et al.
Color Doppler indices of renal allografts depend on vascular stiffness of the transplant recipients
Am J Transplant
(2006) - et al.
Real-time contrast-enhanced sonography of renal transplant recipients predicts chronic allograft nephropathy
Am J Transplant
(2006) - et al.
[Guidelines for the use of contrast agents in ultrasound]
J Radiol
(2005) - et al.
The Banff 97 working classification of renal allograft pathology
Kidney Int
(1999) - et al.
Banff 07 classification of renal allograft pathology: updates and future directions
Am J Transplant
(2008) - et al.
Ultrasonic microbubble contrast agents and the transplant kidney
Clin Radiol
(2009) - et al.
Correlation between the resistive index by Doppler ultrasound and kidney function and histology
Am J Kidney Dis
(2005) - et al.
Evaluation of pre-implantation kidney biopsies: comparison of Banff criteria to a morphometric approach
Kidney Int
(2005) - et al.
Everolimus-based, calcineurin-inhibitor-free regimen in recipients of de-novo kidney transplants: an open-label, randomised, controlled trial
Lancet
(2011)
A phase III study of belatacept-based immunosuppression regimens versus cyclosporine in renal transplant recipients (BENEFIT study)
Am J Transplant
Renal allografts: prospective analysis of Doppler sonography
Radiology
Determinants of intrarenal Doppler indices in stable renal allografts
J Am Soc Nephrol
The renal arterial resistance index and renal allograft survival
N Engl J Med
Ultrasound renal resistive index is not an organ-specific predictor of allograft outcome
Nephrol Dial Transplant
Cited by (25)
The Diagnostic Value of Contrast-Enhanced Ultrasound for Monitoring Complications After Kidney Transplantation—A Systematic Review and Meta-Analysis
2021, Academic RadiologyCitation Excerpt :For patients with kidney function parameters suspicious for acute rejection, CEUS is a safe modality for initial imaging. The quantitative determination of arterial arrival of a ultrasound contrast medium in the early phase after kidney transplantation may identify acute rejection earlier than conventional Doppler ultrasound (29). However, since CEUS cannot differentiate between histologic subtypes, and some histologic subtypes with cellular and humoral components are associated with higher risk of allograft loss, renal biopsy is sometimes inevitable in cases of suspected acute rejection.
Advances of Contrast-Enhanced Ultrasonography and Elastography in Kidney Transplantation: From Microscopic to Microcosmic
2021, Ultrasound in Medicine and BiologyCitation Excerpt :The same group also created a new index derived from the TIC that could discriminate chronic rejection from AR (Yang et al. 2019) Research indicated that RBF estimated by CEUS 1 wk after transplantation correlates well with allograft function 1 y later. Moreover, RBF was found to be associated with biopsy-proven vascular fibrosis and intimal thickening of the allograft (Schwenger et al. 2014). Furthermore, TIC parameters could indicate IF/TA and allograft fibrosis even before the elevation of serum creatinine level, and the parameters correlated well with the expression of fibrosis-associated proteins within the kidney (Zhang et al. 2016).
Quantitative Evaluation of Hepatic Microvascular Perfusion after Ischemia–Reperfusion Injury in Rabbits by Contrast-Enhanced Ultrasound Perfusion Imaging
2018, Ultrasound in Medicine and BiologyCitation Excerpt :The commonly used mathematical models include the bolus injection model, flash-replenishment model and contrast agent depletion model (Fujima et al. 2017; Lassau et al. 2017; Lindsey et al. 2017). CEUS perfusion imaging was initially used for the evaluation of myocardial perfusion (Bulte et al. 2012), and subsequently has been utilized to examine blood perfusion in brain (Bilotta et al. 2016) and kidney (Fischer et al. 2016; Schwenger et al. 2014; Wang and Mohan 2016), tumor angiogenesis (Lassau et al. 2017), and liver cirrhosis grading (Berzigotti et al. 2011). The liver has a double blood supply; 25% to 30% of the blood supply is from the hepatic artery, and 70% to 75% from the portal vein, which increases the complexity of quantitative assessment of hepatic perfusion.
Towards non-invasive diagnostic techniques for early detection of acute renal transplant rejection: A review
2017, Egyptian Journal of Radiology and Nuclear MedicineCitation Excerpt :Additionally, Benozzi et al. [60] discovered that both CEUS and US could identify grafts with early stage dysfunction, but only some CEUS derived parameters could discriminate between AR and ATN. Schwenger et al. [61] exploited the power of CE sonography (CES) in early prediction of long-term renal transplant functionality compared to CD ultrasonography (CDUS). In their study, 68 renal transplants were investigated using both CES and CDUS one week after transplantation.
Use of contrast-enhanced ultrasonography to evaluate chronic allograft nephropathy in rats and correlations between time-intensity curve parameters and allograft fibrosis
2016, Ultrasound in Medicine and BiologyCitation Excerpt :This technology has been used clinically to assess the degree of liver fibrosis in chronic cirrhosis (Liu et al. 2014). In the field of renal transplantation, previous studies have found that CEUS can be used to evaluate the perfusion condition of renal microcirculation for the early detection of CAN (Nankivell et al. 2002; Schwenger et al. 2006), and CEUS can be used as a predictor of graft prognosis (Schwenger et al. 2014). However, there have been no studies on the correlations between CEUS parameters and the degrees of pathologic changes and renal allograft fibrosis associated with CAN.
Pediatric Abdominal Organ Transplantation. Current Indications, Techniques, and Imaging Findings.
2016, Radiologic Clinics of North America
V.S. and V.H. contributed equally to this work.