Abstract
Background: The dynamic tissue perfusion measurement in renal transplants has demonstrated its potential to correlate microvascular perfusion changes with histologic changes in the renal cortex [1]. It has shown in cross sectional studies that the cortical perfusion depends on the time elapsed after transplantation [2,3], but has not yet been applied as a prognostic marker. Therefore, we compared in a prospective 6-year study the initial perfusion measurements with the outcome of the graft function. Method: In 78 renal graft recipients, standardized color Doppler sonographic videos were recorded and cortical perfusion was measured in well-defined regions of interest with the PixelFlux-software. Results: In the beginning of the study, prospectively failing grafts (requiring dialysis) had a significantly lower cortical perfusion compared to grafts with preserved function (0.40 vs. 0.57 cm/s average perfusion intensity of the entire cortex). The interval between perfusion measurement and graft failure was 2.17 years (0 - 6 years). Conclusion: Thus, dynamic tissue perfusion measurement may have a role in the prospective evaluation of renal transplant function. Summary: In 78 transplant recipients, we could demonstrate the prognostic potential of the dynamic color Doppler sonographic perfusion measurement of renal transplants. Perfusion was significantly diminished in those grafts that failed later on within a 6-year period. Thus, cortical perfusion measurement might be valuable as a non-invasive prospective method which reflects the state of the cortical microvasculature.
Highlights
Biopsy of renal transplant remains the cornerstones of renal transplant evaluation, which provides guidance for treatment of graft dysfunction
Twenty-nine patients developed graft failure and 13 patients died during the 6-year follow-up
No significant differences of age at transplantation existed between prospectively failing and non-failing grafts (Table 1(b)). This means that the age had no relevant influence on cortical perfusion of the transplants
Summary
Biopsy of renal transplant remains the cornerstones of renal transplant evaluation, which provides guidance for treatment of graft dysfunction. It carries risks of procedure-related complications from pain to graft loss. The dynamic tissue perfusion measurement in renal transplants has demonstrated its potential to correlate microvascular perfusion changes with histologic changes in the renal cortex [1]. Results: At the beginning of the study, prospectively failing grafts (requiring dialysis) had a significantly lower cortical perfusion compared to grafts with preserved function (0.40 vs 0.57 cm/s average perfusion intensity of the entire cortex). Conclusions: dynamic tissue perfusion measurement may have a role in the prospective evaluation of renal transplant function
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