Noninvasive Assessment of Interstitial Fibrosis and Tubular Atrophy in Renal Transplant by Combining Point-Shear Wave Elastography and Estimated Glomerular Filtration Rate.

Chi Qin,Zhaojie Guan,Yongyan Gao,Haixiang Zhang,Hailong Jin,Yun Zhang

doi:10.3390/diagnostics12010018

Chi Qin, Zhaojie Guan + Show 4 more

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https://doi.org/10.3390/diagnostics12010018

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Journal: Diagnostics	Publication Date: Dec 23, 2021
Citations: 4	License type: CC BY 4.0

Affiliation: Chinese PLA General Hospital

Abstract

The purpose of this study was to evaluate the feasibility of the combination of point-shear wave elastography (p-SWE) and estimated glomerular filtration rate (eGFR) for assessing different stages of interstitial fibrosis and tubular atrophy (IF/TA) in patients with chronic renal allograft dysfunction (CAD). From September 2020 to August 2021, 47 patients who underwent renal biopsy and p-SWE examinations were consecutively enrolled in this study. The areas under the receiver operating characteristic curves (AUCs) were calculated to evaluate overall accuracy and to identify the optimal cutoff values for different IF/TA stages. A total of 43 patients were enrolled in this study. The renal cortical stiffness and eGFR showed a significant difference between IF/TA Grade 0–1 and Grade 2–3 (p < 0.001). Additionally, renal stiffness and eGFR were independent predictors for moderate-to-severe IF/TA (Grade ≥ 2) according to multiple logistic regression analysis. The combination of p-SWE and eGFR, with an optimal cutoff value of −1.63, was superior to eGFR alone in assessing moderate-to-severe interstitial fibrosis (AUC, 0.86 vs. 0.72, p = 0.02) or tubular atrophy (AUC, 0.88 vs. 0.74, p = 0.02). There was no difference between p-SWE and eGFR in assessing moderate-to-severe IF/TA (AUC, 0.85 vs. 0.79, p = 0.61). Therefore, combining p-SWE and eGFR is worthy of clinical popularization and application.

Highlights

Renal transplantation (RT) is an effective tool for the treatment of end-stage renal disease [1]
The current study showed that the combination of point-shear wave elastography (p-Shear wave elastography (SWE)) and estimated glomerular filtration rate (eGFR) has good diagnostic accuracy in assessing moderate-to-severe ci, ct, and interstitial fibrosis and tubular atrophy (IF/TA)
Bom iun kim [24] found that resistance index (RI) was not different between subclinical rejection (SCR) and without SCR groups. These results suggested that RI may not be an effective parameter to evaluate IF/TA stages. eGFR is another parameter usually applied in the evaluation of renal allograft status

Summary

Introduction

Renal transplantation (RT) is an effective tool for the treatment of end-stage renal disease [1]. With the improvement in RT techniques and application of immunosuppressors, the 1-year survival rate for patients with RT has reached 95% [2]. The long-term prognosis of patients has not been improved. Chronic allograft dysfunction (CAD) is the main cause of graft loss after RT [3,4]. Progression of IF/TA is associated with renal function deterioration. Moderate-to-severe IF/TA (Grade ≥ 2) occurs in between 17% and 66% of patients after 5 years of renal transplantation [7]. Renal biopsy is the only reference standard to evaluate IF/TA grades. Evaluating IF/TA grades accurately and noninvasively is essential for CAD patients and important for clinical decision-making

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