Abstract
BackgroundCortical perfusion of the renal transplant can be non-invasively assessed by color Doppler ultrasonography. We performed the Dynamic Tissue Perfusion Measurement (DTPM) of the transplant’s renal cortex using color Doppler ultrasonography (PixelFlux technique), and compared the results with the histopathological findings of transplant biopsies.MethodsNinety-six DTPM studies of the renal transplant’s cortex followed by transplant biopsies were performed in 78 patients. The cortical perfusion data were compared with the parameter of peritubular inflammatory cell accumulation (PTC 0 to 3) based on Banff-classification system.ResultsA significant decrease of cortical perfusion could be demonstrated as the inflammatory cells accumulation in peritubular capillaries increased. Increasing peritubulitis caused a perfusion loss from central to distal layers of 79% in PTC 0, of 85% in PTC 1, of 94% in PTC 2, and of 94% in PTC 3. Furthermore, the perfusion loss due to peritubular inflammation was more prominent in the distal cortical layer. The extent of perfusion decline with increasing peritubulitis (from PTC 0 to PTC 3) was 64% in proximal 20% cortical layer (p20), 63% in proximal 50% cortical layer (p50), increased to 76% in distal 50% cortical layer (d50), and peaked at 90% in the distal 20% cortical layer (d20). For those without peritubulitis (PTC 0), the increase in the the Interstitial Fibrosis/Tubular Atrophy (IF/TA) score was accompanied by a significantly increased cortical perfusion. A Polyomavirus infection was associated with an increased cortical perfusion.ConclusionsOur study demonstrated that the perfusion of the renal transplant is associated with certain pathological changes within the graft. DTPM showed a significant reduction of cortical perfusion in the transplant renal cortex related to peritubular capillary inflammation.
Highlights
Cortical perfusion of the renal transplant can be non-invasively assessed by color Doppler ultrasonography
Dynamic Tissue Perfusion Measurement (DTPM) showed a significant reduction of cortical perfusion in the transplant renal cortex related to peritubular capillary inflammation
Resistance Index (RI) showed a weaker connection to peritubular inflammation than did cortical tissue perfusion with only one significant difference between the peritubular capillaritis (PTCs)-classes compared to five significant differences among the DTPM measurements (Figure 3)
Summary
Cortical perfusion of the renal transplant can be non-invasively assessed by color Doppler ultrasonography. We performed the Dynamic Tissue Perfusion Measurement (DTPM) of the transplant’s renal cortex using color Doppler ultrasonography (PixelFlux technique), and compared the results with the histopathological findings of transplant biopsies. Acute and chronic damage to renal transplants requires an early and accurate diagnosis to start the appropriate treatment. Renal transplant biopsies are an established method to evaluate such changes. These biopsies are performed as routine protocol biopsies in regular intervals in asymptomatic recipients or are performed when a clinical demand emerges. Biopsies are invasive and a need for less potentially harmful procedures exists. Sonography is widely used to describe morphological changes of the transplant.
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