Diagnosis of renal transplant failure by real-time and duplex Doppler sonography

Decrease in 1-year Kidney Graft Size Predicts Inferior Outcomes After Deceased Donor Kidney Transplantation

BACKGROUND

Longest bipolar length of the kidney graft is routinely measured for ultrasonographic assessment of graft size (GS), although the value of the graft length remains unclear.

METHODS

In a single-center, observational study involving 319 deceased-donor kidney transplant recipients, we assessed variations in absolute and adjusted GS (corrected for body surface area) between 1 and 12 months after transplantation ([INCREMENT]GS1m→12m). We tested whether variations in GS during the first year were predictive of the composite outcome of a reduction of 50% or more in the estimated glomerular filtration rate or end-stage graft failure.

RESULTS

At 1 year after transplantation, 121 patients (38%) had a decrease in GS ([INCREMENT]GS1m→12m <0), and 198 patients (62%) had an increase in GS ([INCREMENT]GS1m→12m ≥0). After a median follow-up of 53 months, 41 patients with a decrease in GS reached the composite outcome as compared with 12 patients with an increase in GS (34% and 6%, respectively; P < 0.001). Areas under the receiver operating characteristics curves of absolute and adjusted [INCREMENT]GS1m→12m for composite outcome were 0.81 (95% confidence interval [95% CI], 0.74-0.88) and 0.78 (95% CI, 0.70-0.86), respectively. In multivariate analysis, the risk of the composite outcome was significantly higher among patients with a decrease in GS during the first year after transplantation (hazard ratio, 4.55; 95% CI, 2.35-8.81; P < 0.001).

CONCLUSIONS

A decrease in kidney GS during the first year after transplantation, as compared with an increase in GS, is a powerful predictor of subsequent graft dysfunction or end-stage graft failure.

Renal Artery Resistance Index, Thyroid Hormones, and Thyroid Volume in the Early Kidney Transplants Recipients

BACKGROUND

Thyroid hormones could affect renal function, and, on the other hand, renal dysfunction may affect thyroid function. Disturbances of concentrations of thyroid hormones are often associated with thyroid gland enlargement. The aim of the study was to assess the function and morphology of the thyroid (volume and hormones concentration) and kidney function after transplantation (creatinine concentration and resistance index [RI] of transplant artery).

MATERIAL AND METHODS

The group included 13 females, 19 males; aged 19-69 years, mean 44.75 +/- 14.8 years after transplantation with stable graft function. Thyroid volume, renal artery RI, creatinine concentration, and concentrations of T3, rT3, FT3, FT4, and TSH were estimated the day before surgery, and at 1, 3, 6, and 10 days after transplantation.

RESULTS

The statistical analysis revealed a negative correlation between delta RI (difference between RI at 3 and 6 days after transplantation) and serum creatinine concentration, 10 days after transplantation (r = -0.63; P < 0.01). We also observed a negative correlation between creatinine serum concentration at 10 days after transplantation and delta thyroid volume (Delta Vol; r = - 0.48; p < .05), a positive correlation between delta FT4 (Delta FT4) serum concentration, and delta creatinine (Delta Crea; r = 0.73; P < .001).

CONCLUSIONS

The dynamics of RI changes in the transplant kidney artery between 3 and 6 days after transplantation may predict graft function. Together with improved kidney function at 10 days after transplantation, we observed a regression of goiter.

Quantitation of change in the medullary compartment in renal allograft by ultrasound

Twenty-three renal allograft recipients with uncomplicated post-transplant courses were sonographically evaluated on the 3rd, 10th, 30th, and 90th post-operative day. The cortical thickness (CT), pyramidal length (PL), pyramidal width (PW), corticomedullary ratio (CMR), and medullary pyramidal index (MPI) were determined at each examination. The measurements obtained from the donor before implantation were used as the baseline. PW increased significantly in the absence of rejection and obstruction in renal allograft during the early post-transplant period. Although the MPI, and to a lesser extent the CMR, detected changes in dimensions of the medullary compartment, there was considerable intra- and inter-individual variation in their values during the post-operative period.