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Role of color Doppler ultrasound in the evaluation of renal transplantation from living donors



Role of color Doppler ultrasound in the evaluation of renal transplantation from living donors



Journal of Ultrasound 17(3): 207-213



The aim of this study was to evaluate the same kidney before and after transplantation to assess the ability of the allograft to restore blood flow, time required to achieve functional recovery after surgery and the possibility of differentiating normal from pathological allografts using color Doppler ultrasound (CDUS) flow indices: resistive index (RI)/renal cortical ratio (RCR) and scintigraphy. 79 living donors and 79 recipients. Donors underwent renal CDUS and scintigraphy. CDUS was repeated on the allograft 24 h, 3, 15 and 30 days after transplantation, and scintigraphy 3-5 days after transplantation. Recipients were divided into two groups on the basis of clinical and biochemical values: (A) well-functioning allografts and (B) acute pathology. Results of CDUS, RI and RCI were compared to results of scintigraphy, biochemical values and biopsy. Group (A) n = 60 (76 %), group (B) n = 19 (24 %); RI sensitivity was 93 %, specificity 83 %. In group (A) positive predictive value (PPV) was 94 % and in group (B) 90 %. RCR using receiver operating characteristic curve analysis yielded sensitivity 100 % and specificity 98.3 %. Scintigraphy mean values of glomerular filtration ratio and T max before transplantation were in group (A): 50.32 ml/min and 4.87 min; after transplantation 46.88 ml/min and 4.96 min; in group (B): 48.68 ml/min and 4.63 min, after transplantation 27.89 ml/min and 10.53 min, respectively. Pearson's correlation coefficient between preoperative and postoperative results of scintigraphy was significant in group (A) (glomerular filtration ratio = 0.85, T max = 0.70) and not significant in group (B) (glomerular filtration ratio = 0.40, T max = 0.08). This study shows that CDUS, RI and RCR are useful in postoperative evaluation of transplanted kidneys as these parameters can, after only 24 h, confirm the good condition of the allograft despite still excessive blood parameter values. Scopo di questo studio è stato di valutare lo stesso rene prima e dopo il trapianto al fine di valutare la capacità dell’organo trapianto di ripristinare il flusso sanguigno, il tempo richiesto per raggiungere il recupero funzionale dopo l’intervento chirurgico e per differenziare nell’innesto il tessuto normale dal patologico con l’uso degli indici di flusso del color Doppler (CD): l’indice di resistenza (IR)/renal cortical ratio (RCR) e la scintigrafia. 79 donatori viventi e 79 riceventi. I donatori sono stati sottoposti a CD renale e a scintigrafia. Il CD è stato ripetuto sul tessuto trapiantato 24 ore, 3, 15 e 30 giorni dopo il trapianto e la scintigrafia, 3-5 giorni dopo il trapianto. I pazienti sono stati divisi in due gruppi sulla base dei dati clinici e biochimici: A) trapianto ben funzionante e B) patologia acuta. I risultati del CD, IR e RCR sono stati confrontati con i risultati della scintigrafia, i valori biochimici e la biopsia. Gruppo A) n = 60 (76 %), gruppo B) n = 19 (24 %); la sensibilità del IR è stata del 93 %, la specificità del 83 %. Nel gruppo A) il valore predittivo positivo (VPP) è stato: 94 %, gruppo B): 90 %. Utilizzando una analisi delle curve ROC (Receiver Operating Characteristic) lo RCR ha prodotto una sensibilità del 100 % e una specificità del 98,3 %. I valori medi della scintigrafia del rapporto di filtrazione glomerulare e Tmax prima del trapianto nel gruppo A): 50.32 ml/min e 4.87 min; dopo trapianto 46.88 ml/min e 4.96 min; nel gruppo B): 48.68 ml/min e 4.63 min, dopo trapianto di 27,89 ml/min e 10.53 minuti, rispettivamente. Il coefficiente di correlazione di Pearson tra i risultati preoperatori e postoperatori della scintigrafia è stato significativo nel gruppo A) (rapporto di filtrazione glomerulare = 0,85, Tmax = 0,70) e non significativa nel gruppo B) (rapporto di filtrazione glomerulare = 0.40, Tmax = 0,08). Questo studio dimostra che CD, IR e RCR sono utili nella valutazione postoperatoria dei reni trapiantati in quanto tali parametri possono, dopo solo 24 ore, confermare la buona condizione del tessuto trapiantato nonostante i valori ematochimici ancora alterati.

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Accession: 055602693

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PMID: 25177394

DOI: 10.1007/s40477-014-0077-6


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