99Tcm-DTPA renal dynamic imaging for detecting renal function before liver transplantation and predicting early acute kidney injury postoperation

Abstract

Objective To investigate the value of 99Tcm-diethylene triamine pentoacetic acid (DTPA) renal dynamic imaging for detecting renal function before liver transplantation and predicting early acute kidney injury (AKI) postoperation. Methods A total of 40 patients (29 males, 11 females, average age (45±8) years) with end-stage liver diseases who underwent orthotopic liver transplantation from June 2015 to June 2016 were selected in this retrospective study. All patients underwent 99Tcm-DTPA renal dynamic imaging within one week before liver transplantation, the general glomerular filtration rate (GFR) and normalized GFR (NGFR) were calculated. The serum creatinine (SCr) and blood urea were detected during the perioperative period. Patients were divided into AKI group (n=15) and non-AKI group (n=25) according to whether the patients suffered from AKI 3 d after liver transplantation. The general GFR, NGFR, SCr and blood urea between two groups were compared using two-sample t test. The sensitivities and specificities of general GFR and NGFR for predicting AKI were evaluated by receiver operating characteristic (ROC) curve. Correlations between general GFR, NGFR and SCr, blood urea before liver transplantation were investigated by Pearson correlation analysis. Results The general GFR, NGFR before operation in AKI group were significantly lower than those in non-AKI group: (58.6±7.7) ml/min vs (77.3±12.3) ml/min, (57.7±7.5) ml·min-1·1.73 m-2vs (76.8±12.6) ml·min-1·1.73 m-2 (t values: -5.924, -5.981, both P 0.05). The area under curve (AUC) of general GFR and NGFR was 0.947 and 0.944, respectively. The early AKI was predicted by general GFR and NGFR under the cut-off<60 ml/min and <60 ml·min-1·1.73 m-2 with sensitivities of 9/15, 10/15 and specificities both of 96.0%(24/25). There were negative correlations between the general GFR and SCr, general GFR and blood urea, NGFR and SCr, NGFR and blood urea (r values: -0.555, -0.391, -0.562, -0.390, all P<0.05). Conclusions 99Tcm-DTPA renal dynamic imaging is helpful for the early detection of potential injury of the renal function. Both general GFR and NGFR could be the accurate indicators for predicting early AKI following orthotopic liver transplantation. Key words: End stage liver diseases; Liver transplantation; Acute kidney injury; Radionuclide imaging; Technetium Tc 99m pentetate