Utilidad de la gammagrafía con plaquetas marcadas con 111In-oxina en el manejo del síndrome febril en pacientes en diálisis portadores de injerto renal no funcionante

Abstract

Aim To evaluate the usefulness of 111In-oxinelabelled platelet scan in the therapeutic management of prolonged febrile syndrome in dialysis patients with a non-functional renal allograft. Material and methods One hundred and fifty-eight patients (94 men, 64 women; mean age 44 ± 9 years) were studied. Duration of fever was 42 days (range 7-112). A total of 68 % of the patients (107/158) were on low doses of corticosteroids (< 10 mg/day). Platelet scans were performed 48 hours after reinjection of 111In-ixone-labelled platelets. A platelet uptake index (PUI) was calculated by dividing the cpm/pixel in the allograft by the cpm/pixel in a mirror background. A PUI ≥ 1.5 was considered as threshold for immunological fever. The final diagnosis of immunological fever was established when it disappeared after transplantectomy, embolization or high doses of corticosteroid therapy. Fever of non-immunological origin was established when it disappeared after antibiotic therapy. Results In 102/158 patients the fever was considered of immunological origin. In 56/158 patients the fever was considered of non immunological origin. Sensitivity and the specificity of the platelet scan was 80 % and 100 %, respectively. All those patients considered as having fever of immunological origin who had PUI < 1.5 had been using corticosteroids during platelet scan. Conclusion 111In-labelled platelet scintigraphy is a useful technique in the therapeutic management of prolonged febrile syndrome in dialysis patients with non-functional renal allograft. The use of corticosteroids can reduce the sensitivity of 111In- labelled platelet scan.