Abstract
Patients after solid organ kidney transplantation (KTX) often suffer from acute kidney injury (AKI). Parameters as serum creatinine indicate a loss of kidney function, although no distinction of the cause and prognosis can be made. Imaging tools measuring kidney function have not been widely in clinical use. In this observational study we evaluated 2-deoxy-2[18F] fluoro-D-glucose (FDG) PET/MRI in thirteen patients after KTX with AKI as a functional assessment of the graft. Twenty-four healthy volunteers served as control. General kidney performance (GKP), initial flow (IF) and renal response function (RF) were calculated by standardized uptake values (SUV) and time activity curves (TAC). The GKP measured for the total kidney and medulla was significantly higher in healthy patients compared to patients after KTX (p = 0.0002 and p = 0.0004, respectively), but no difference was found for the GKP of the cortex (p = 0.59). The IF in KTX patients correlated with renal recovery, defined as change in serum creatinine 10 days after PET/MRI (r = 0.80, p = 0.001). With regard to the RF, a negative correlation for tubular damage was found (r = −0.74, p = 0.004). In conclusion, parameters obtained from FDG PET/MRI showed a possible predictive feature for renal recovery in KTX patients undergoing AKI.
Highlights
Within the first year after kidney transplantation (KTX) postoperative monitoring and care is crucial for patients’ outcome
Renal recovery following transplantation or kidney injury due to acute events differs markedly and no reliable parameters are available in predicting the time span of allograft function regain[20,21]
Thirteen kidney recipients admitted to hospital due to Delayed graft function (DGF) or kidney function deterioration were enrolled in the study
Summary
Within the first year after kidney transplantation (KTX) postoperative monitoring and care is crucial for patients’ outcome. Renal tubular cells are capable of replicating and can repopulate injured regions This reflects the organ specific regenerative potential and is variable from individual to individual[17,18,19]. Renal recovery following transplantation or kidney injury due to acute events differs markedly and no reliable parameters are available in predicting the time span of allograft function regain[20,21]. Various biomarkers have been tested for their diagnostic value for partial or full organ recovery following AKI in transplant recipients[22,23,24,25] Markers such as KIM-1, IGFBP7, TIMP-2 and other have shown promising results in predicting delayed graft function prior to known laboratory tests[26]. With dynamic scans the behavior of the tracer can be observed in the kidneys, undergoing several renal processes such as filtration, re-absorption and excretion[39]
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