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Expert Panel on Urological Imaging, Taffel MT, Khatri G, Purysko AS, Avery R, Caserta MP, Chang SD, De Leon AD, Ganeshan D, Gupta RT, Lew SQ, Lyshchik A, Nicola R, Piel C, Sener A, Smith AD, Nikolaidis P. ACR Appropriateness Criteria® Renal Transplant Dysfunction: 2024 Update. J Am Coll Radiol 2025; 22:S372-S395. [PMID: 40409889 DOI: 10.1016/j.jacr.2025.02.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2025] [Accepted: 02/24/2025] [Indexed: 05/25/2025]
Abstract
Renal transplantation remains the treatment of choice in patients with end-stage renal disease as the 5-year survival rates for the graft in renal transplant patients range from 72% to 99%. Despite improvements in graft survival related to increased efficacy of immunosuppression drugs and improvements in surgical technique, various complications do occur. Ultrasound is the first-line imaging modality for the evaluation of renal transplants in the immediate postoperative period and for longitudinal follow-up. Various other imaging techniques serve as complementary examinations in specific clinical settings. Angiography remains the reference standard for arterial complications and is used for nonsurgical intervention, but noninvasive CT or MR angiography could be considered prior to an invasive procedure. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Affiliation(s)
| | - Myles T Taffel
- New York University Langone Medical Center, New York, New York.
| | - Gaurav Khatri
- Panel Chair, UT Southwestern Medical Center, Dallas, Texas
| | | | - Ryan Avery
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Commission on Nuclear Medicine and Molecular Imaging
| | | | - Silvia D Chang
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | - Rajan T Gupta
- Duke University Medical Center, Durham, North Carolina
| | - Susie Q Lew
- George Washington University, Washington, District of Columbia; American Society of Nephrology
| | - Andrej Lyshchik
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Refky Nicola
- SUNY Upstate Medical University, Syracuse, New York
| | - Carl Piel
- UT Southwestern Medical Center, Dallas, Texas; American College of Emergency Physicians
| | - Alp Sener
- Western University, London, Ontario, Canada; American Urological Association
| | - Andrew D Smith
- University of Alabama at Birmingham, Birmingham, Alabama
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Fogaing IM, Abdo A, Ballis-Berthiot P, Adrian-Felix S, Olagne J, Merieux R, Vuiblet V. Detection and classification of glomerular lesions in kidney graft biopsies using 2-stage deep learning approach. Medicine (Baltimore) 2025; 104:e41560. [PMID: 39960931 PMCID: PMC11835116 DOI: 10.1097/md.0000000000041560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2024] [Accepted: 01/30/2025] [Indexed: 02/20/2025] Open
Abstract
Acute allograft rejection in patients undergoing renal transplantation is diagnosed through histopathological analysis of renal graft biopsies, which can be used to quantify elementary lesions. However, quantification of elementary lesions requires considerable expertise, time, and effort. Using a 2-stage classification strategy, we sought to examine the effectiveness of deep learning in detecting and classifying glomeruli into 4 groups, namely normal, abnormal, sclerotic, and glomerulitis, as a potential biopsy triage system focused on transplant rejection. We used the U-Net model to build a glomeruli detection model using 137 kidney biopsy slides obtained from 80 kidney transplant patients. The median age of the patients was 52 (19-74) years, with 65% being men and 35% women. MobileNetV2 and VGG16 models were compared using a 2-stage classification strategy. In the first classification step, the models classified glomeruli into sclerotic and nonsclerotic glomeruli. In the second classification step, the nonsclerotic glomeruli from the first step were classified as normal, abnormal, or glomerulitis. The U-Net model achieved satisfactory detection (Dice coefficient = 0.90), and the MobileNetV2 model was the best for the 2 classification steps, with F1 scores of 0.85, 0.91, 0.98, and 0.92 for normal, abnormal, sclerotic, and glomerulitis, respectively. The 2-stage classification strategy identifies sclerotic glomeruli and abnormal glomeruli relative to permeable glomeruli and quantifies glomerulitis with significant accuracy while avoiding bias from abnormal glomeruli that do not have glomerulitis, providing valuable diagnostic information.
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Affiliation(s)
- Irène Mappé Fogaing
- IIAS – Institute of Artificial Intelligence in Health, CHU de Reims, Université de Reims Champagne-Ardenne, Reims, France
| | - Ammar Abdo
- IIAS – Institute of Artificial Intelligence in Health, CHU de Reims, Université de Reims Champagne-Ardenne, Reims, France
| | - Pavlina Ballis-Berthiot
- Department of Pathology, University Hospital Saint-Louis, Public Assistance Paris Hospitals, Paris, France
| | | | - Jérôme Olagne
- Department of Nephrology, Kidney Transplantation and Hemodialysis, Strasbourg University Hospital, Strasbourg, France
| | - Rudy Merieux
- IIAS – Institute of Artificial Intelligence in Health, CHU de Reims, Université de Reims Champagne-Ardenne, Reims, France
| | - Vincent Vuiblet
- IIAS – Institute of Artificial Intelligence in Health, CHU de Reims, Université de Reims Champagne-Ardenne, Reims, France
- Department of Pathology, CHU de Reims, Reims, France
- Department of Nephrology, CHU de Reims, Reims, France
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Ettenger RB, Seifert ME, Blydt-Hansen T, Briscoe DM, Holman J, Weng PL, Srivastava R, Fleming J, Malekzadeh M, Pearl M. Detection of Subclinical Rejection in Pediatric Kidney Transplantation: Current and Future Practices. Pediatr Transplant 2024; 28:e14836. [PMID: 39147695 DOI: 10.1111/petr.14836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Revised: 07/19/2024] [Accepted: 07/22/2024] [Indexed: 08/17/2024]
Abstract
INTRODUCTION The successes in the field of pediatric kidney transplantation over the past 60 years have been extraordinary. Year over year, there have been significant improvements in short-term graft survival. However, improvements in longer-term outcomes have been much less apparent. One important contributor has been the phenomenon of low-level rejection in the absence of clinical manifestations-so-called subclinical rejection (SCR). METHODS Traditionally, rejection has been diagnosed by changes in clinical parameters, including but not limited to serum creatinine and proteinuria. This review examines the shortcomings of this approach, the effects of SCR on kidney allograft outcome, the benefits and drawbacks of surveillance biopsies to identify SCR, and new urine and blood biomarkers that define the presence or absence of SCR. RESULTS Serum creatinine is an unreliable index of SCR. Surveillance biopsies are the method most utilized to detect SCR. However, these have significant drawbacks. New biomarkers show promise. These biomarkers include blood gene expression profiles and donor derived-cell free DNA; urine gene expression profiles; urinary cytokines, chemokines, and metabolomics; and other promising blood and urine tests. CONCLUSION Specific emphasis is placed on studies carried out in pediatric kidney transplant recipients. TRIAL REGISTRATION ClinicalTrials.gov: NCT03719339.
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Affiliation(s)
- Robert B Ettenger
- Division of Nephrology, Department of Pediatrics, UCLA Mattel Children's Hospital, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Michael E Seifert
- Division of Pediatric Nephrology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Tom Blydt-Hansen
- Multi-Organ Transplant Program, British Columbia Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - David M Briscoe
- Division of Nephrology, Department of Pediatrics Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - John Holman
- Transplant Genomics Inc., Framingham, Massachusetts, USA
| | - Patricia L Weng
- Division of Nephrology, Department of Pediatrics, UCLA Mattel Children's Hospital, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Rachana Srivastava
- Division of Nephrology, Department of Pediatrics, UCLA Mattel Children's Hospital, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - James Fleming
- Transplant Genomics Inc., Framingham, Massachusetts, USA
| | - Mohammed Malekzadeh
- Division of Nephrology, Department of Pediatrics, UCLA Mattel Children's Hospital, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Meghan Pearl
- Division of Nephrology, Department of Pediatrics, UCLA Mattel Children's Hospital, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
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Filipov T, Teutsch B, Szabó A, Forintos A, Ács J, Váradi A, Hegyi P, Szarvas T, Ács N, Nyirády P, Deák PÁ. Investigating the role of ultrasound-based shear wave elastography in kidney transplanted patients: correlation between non-invasive fibrosis detection, kidney dysfunction and biopsy results-a systematic review and meta-analysis. J Nephrol 2024; 37:1509-1522. [PMID: 38427308 PMCID: PMC11473454 DOI: 10.1007/s40620-023-01856-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 11/28/2023] [Indexed: 03/02/2024]
Abstract
INTRODUCTION Interstitial fibrosis and tubular atrophy are leading causes of renal allograft failure. Shear wave elastography could be a promising noninvasive method for providing information on the state of the kidney, with specific regard to fibrosis but currently available data in the literature are controversial. Our study aimed to analyze the correlation between shear wave elastography and various kidney dysfunction measures. METHODS This review was registered on PROSPERO (CRD42021283152). We systematically searched three major databases (MEDLINE, Embase, and CENTRAL) for articles concerning renal transplant recipients, shear wave elastography, fibrosis, and kidney dysfunction. Meta-analytical calculations for pooled Pearson and Spearman correlation coefficients (r) were interpreted with 95% confidence intervals (CIs). Heterogeneity was tested with Cochran's Q test. I2 statistic and 95% CI were reported as a measurement of between-study heterogeneity. Study quality was assessed with the QUADAS2 tool. RESULTS In total, 16 studies were included in our meta-analysis. Results showed a moderate correlation between kidney stiffness and interstitial fibrosis and tubular atrophy, graded according to BANFF classification, on biopsy findings for pooled Pearson (r = 0.48; CI: 0.20, 0.69; I2 = 84%) and Spearman correlations (r = 0.57; CI: 0.35, 0.72; I2 = 74%). When compared to kidney dysfunction parameters, we found a moderate correlation between shear wave elastography and resistive index (r = 0.34 CI: 0.13, 0.51; I2 = 67%) and between shear wave elastography and estimated Glomerular Filtration Rate (eGFR) (r = -0.65; CI: - 0.81, - 0.40; I2 = 73%). All our outcomes had marked heterogeneity. CONCLUSION Our results showed a moderate correlation between kidney stiffness measured by shear wave elastography and biopsy results. While noninvasive assessment of kidney fibrosis after transplantation is an important clinical goal, there is insufficient evidence to support the use of elastography over the performance of a kidney biopsy.
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Affiliation(s)
- Teodóra Filipov
- Department of Interventional Radiology, Heart and Vascular Center, Faculty of Medicine, Semmelweis University, Határőr ut 18, 1122, Budapest, Hungary
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Brigitta Teutsch
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
- Institute for Translational Medicine, Medical School University of Pécs, Pécs, Hungary
- Institute of Pancreatic Diseases, Semmelweis University, Budapest, Hungary
| | - Anett Szabó
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
- Department of Urology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Attila Forintos
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Júlia Ács
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
- Department of Urology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Alex Váradi
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
- Department of Laboratory Medicine, Medical School, University of Pécs, Pécs, Hungary
- Department of Metagenomics, University of Debrecen, Debrecen, Hungary
| | - Péter Hegyi
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
- Institute for Translational Medicine, Medical School University of Pécs, Pécs, Hungary
- Institute of Pancreatic Diseases, Semmelweis University, Budapest, Hungary
| | - Tibor Szarvas
- Department of Urology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
- Department of Urology, University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany
| | - Nándor Ács
- Department of Obstetrics and Gynecology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Péter Nyirády
- Department of Urology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Pál Ákos Deák
- Department of Interventional Radiology, Heart and Vascular Center, Faculty of Medicine, Semmelweis University, Határőr ut 18, 1122, Budapest, Hungary.
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Bane O, Seeliger E, Cox E, Stabinska J, Bechler E, Lewis S, Hickson LJ, Francis S, Sigmund E, Niendorf T. Renal MRI: From Nephron to NMR Signal. J Magn Reson Imaging 2023; 58:1660-1679. [PMID: 37243378 PMCID: PMC11025392 DOI: 10.1002/jmri.28828] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 05/11/2023] [Accepted: 05/12/2023] [Indexed: 05/28/2023] Open
Abstract
Renal diseases pose a significant socio-economic burden on healthcare systems. The development of better diagnostics and prognostics is well-recognized as a key strategy to resolve these challenges. Central to these developments are MRI biomarkers, due to their potential for monitoring of early pathophysiological changes, renal disease progression or treatment effects. The surge in renal MRI involves major cross-domain initiatives, large clinical studies, and educational programs. In parallel with these translational efforts, the need for greater (patho)physiological specificity remains, to enable engagement with clinical nephrologists and increase the associated health impact. The ISMRM 2022 Member Initiated Symposium (MIS) on renal MRI spotlighted this issue with the goal of inspiring more solutions from the ISMRM community. This work is a summary of the MIS presentations devoted to: 1) educating imaging scientists and clinicians on renal (patho)physiology and demands from clinical nephrologists, 2) elucidating the connection of MRI parameters with renal physiology, 3) presenting the current state of leading MR surrogates in assessing renal structure and functions as well as their next generation of innovation, and 4) describing the potential of these imaging markers for providing clinically meaningful renal characterization to guide or supplement clinical decision making. We hope to continue momentum of recent years and introduce new entrants to the development process, connecting (patho)physiology with (bio)physics, and conceiving new clinical applications. We envision this process to benefit from cross-disciplinary collaboration and analogous efforts in other body organs, but also to maximally leverage the unique opportunities of renal physiology. LEVEL OF EVIDENCE: 1 TECHNICAL EFFICACY STAGE: 2.
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Affiliation(s)
- Octavia Bane
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
- Icahn School of Medicine at Mount Sinai, BioMedical Engineering and Imaging Institute, New York City, New York, USA
| | - Erdmann Seeliger
- Institute of Translational Physiology, Charité-University Medicine Berlin, Berlin, Germany
| | - Eleanor Cox
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, Nottingham, UK
| | - Julia Stabinska
- F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Maryland, USA
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Eric Bechler
- Department of Diagnostic and Interventional Radiology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Sara Lewis
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - LaTonya J Hickson
- Division of Nephrology and Hypertension, Mayo Clinic, Jacksonville, Florida, USA
| | - Sue Francis
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, Nottingham, UK
| | - Eric Sigmund
- Bernard and Irene Schwartz Center for Biomedical Imaging Center for Advanced Imaging Innovation and Research (CAI2R), New York University Langone Health, New York City, New York, USA
| | - Thoralf Niendorf
- Berlin Ultrahigh Field Facility (B.U.F.F.), Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany
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Schnuelle P. Renal Biopsy for Diagnosis in Kidney Disease: Indication, Technique, and Safety. J Clin Med 2023; 12:6424. [PMID: 37835066 PMCID: PMC10573674 DOI: 10.3390/jcm12196424] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 09/29/2023] [Accepted: 10/04/2023] [Indexed: 10/15/2023] Open
Abstract
Renal biopsies are the gold standard for diagnosis, staging, and prognosis of underlying parenchymal kidney disease. This article provides an overview of the current indications and highlights ways to reduce bleeding complications in order to achieve optimal diagnostic yield with minimal risk to the patient. Novel indications have emerged from the increasing use of new molecularly targeted oncologic therapies in recent years, which often induce immune-mediated renal disease. On the other hand, the detection of specific antibodies against target antigens on podocytes in the sera of patients with new-onset nephrotic syndrome has now relativized the indication for biopsy in membranous nephropathy. The use of semi-automatic spring-loaded biopsy devices and real-time ultrasound considerably declined the complication rate and is the current standard. Percutaneous renal biopsies are overall a safe procedure if contraindications are considered. A coagulation disorder needs to be excluded beforehand, and an elevated blood pressure must be reduced to the normotensive range with medications. A laparoscopic approach or a radiology interventional procedure through the internal jugular vein may be considered for obtaining a kidney tissue sample if there is an urgent indication and a bleeding tendency cannot be adequately corrected. Major bleeding after a percutaneous renal biopsy can usually be managed with selective arterial embolization of the injured renal vessel. The use of a 16-gauge needle is the most reasonable compromise between diagnostic benefit and risk of complication. In the routine diagnostic, the biopsy specimen is examined with light microscopy, immunohistochemistry, and electron microscopy. Combination with modern molecular pathology techniques will contribute to more precise insights into the development and progression of kidney disease, which will likely refine future treatments in nephrology.
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Affiliation(s)
- Peter Schnuelle
- Center for Renal Diseases Weinheim, Academic Teaching Practice of the University Medical Center Mannheim, University of Heidelberg, D-69469 Weinheim, Germany
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Lee HK, Jung NH, Lee DE, Lee H, Yang J, Kim YS, Han SS, Han N, Kim IW, Oh JM. Discovery of Biomarkers Related to Interstitial Fibrosis and Tubular Atrophy among Kidney Transplant Recipients by mRNA-Sequencing. J Pers Med 2023; 13:1242. [PMID: 37623492 PMCID: PMC10455123 DOI: 10.3390/jpm13081242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 07/28/2023] [Accepted: 08/08/2023] [Indexed: 08/26/2023] Open
Abstract
Interstitial fibrosis and tubular atrophy (IF/TA) after kidney transplantation causes a chronic deterioration of graft function. IF/TA can be diagnosed by means of a graft biopsy, which is a necessity as non-invasive diagnostic methods are unavailable. In this study, we identified IF/TA-related differentially expressed genes (DEGs) through next-generation sequencing using peripheral blood mononuclear cells. Blood samples from kidney transplant recipients undergoing standard immunosuppressive therapy (tacrolimus/mycophenolate mofetil or mycophenolate sodium/steroid) and diagnosed as IF/TA (n = 41) or normal (controls; n = 41) at their one-year protocol biopsy were recruited between January of 2020 and August of 2020. DEGs were derived through mRNA sequencing and validated by means of a quantitative real-time polymerase chain reaction. We identified 34 DEGs related to IF/TA. ADAMTS2, PLIN5, CLDN9, and KCNJ15 demonstrated a log2(fold change) of >1.5 and an area under the receiver operating characteristic curve (AUC) value of >0.6, with ADAMTS2 showing the largest AUC value and expression levels, which were 3.5-fold higher in the IF/TA group relative to that observed in the control group. We identified and validated DEGs related to IF/TA progression at one-year post-transplantation. Specifically, we identified ADAMTS2 as a potential IF/TA biomarker.
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Affiliation(s)
- Hyun Kyung Lee
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul 08826, Republic of Korea; (H.K.L.)
| | - Na Hyun Jung
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul 08826, Republic of Korea; (H.K.L.)
| | - Da Eun Lee
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul 08826, Republic of Korea; (H.K.L.)
| | - Hajeong Lee
- Division of Nephrology, Department of Internal Medicine, Seoul National University Hospital, Seoul 03080, Republic of Korea (Y.S.K.)
- Internal Medicine, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
| | - Jaeseok Yang
- Transplantation Center, Seoul National University Hospital, Seoul 03080, Republic of Korea
- Division of Nephrology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Yon Su Kim
- Division of Nephrology, Department of Internal Medicine, Seoul National University Hospital, Seoul 03080, Republic of Korea (Y.S.K.)
- Internal Medicine, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
| | - Seung Seok Han
- Division of Nephrology, Department of Internal Medicine, Seoul National University Hospital, Seoul 03080, Republic of Korea (Y.S.K.)
- Internal Medicine, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
| | - Nayoung Han
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul 08826, Republic of Korea; (H.K.L.)
- College of Pharmacy, Jeju National University, Jeju 63243, Republic of Korea
| | - In-Wha Kim
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul 08826, Republic of Korea; (H.K.L.)
| | - Jung Mi Oh
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul 08826, Republic of Korea; (H.K.L.)
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Aoki Y, Kawamura T, Shiraga N, Yonekura T, Maeda M, Kurihara S, Sekine Y, Shishido S, Sakai K. Arteriovenous fistula in a renal allograft with gross hematuria and subsequent acute kidney injury due to urinary tract obstruction: a case report. BMC Nephrol 2023; 24:156. [PMID: 37277729 DOI: 10.1186/s12882-023-03183-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 04/26/2023] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND Arteriovenous fistula (AVF) due to renal allograft biopsy is mechanical trauma resulting from the penetration of small arteries and veins by a core needle. Most AVFs are reported to resolve asymptomatically and spontaneously. This report presents a patient with acute kidney injury (AKI) due to urinary tract obstruction caused by a bleeding AVF in a renal allograft. CASE PRESENTATION A 22-year-old Japanese woman who underwent living-donor kidney transplantation (KT) at 3 years due to end-stage renal disease caused by focal segmental glomerulosclerosis (FSGS) presented with a renal transplant AVF (gourd-shaped; 42 × 19 × 20 mm). The AVF was unexpectedly discovered by ultrasound before a surveillance biopsy at 10 years after KT. The patient had a history of recurrent FSGS, had undergone several renal allograft biopsies after KT, and did not experience symptoms or growth of the AVF for years. Nineteen years after KT, the patient developed AKI with sudden, asymptomatic, gross hematuria and anuria. Plain computed tomography revealed a hematoma in the pelvis of the renal allograft and bladder tamponade. The AVF was successfully treated by coil embolization. Hemodialysis was performed for AKI, and graft function was gradually recovered. CONCLUSIONS Unexpected bleeding from a renal transplant AVF may lead to transplant dysfunction. Angiographic embolization against the ruptured renal transplant AVF may prevent rebleeding and rescue the renal allograft.
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Affiliation(s)
- Yujiro Aoki
- Department of Nephrology, Toho University Faculty of Medicine, 6-11-1 Omori-Nishi, Ota-ku, Tokyo, 143-8541, Japan.
| | - Takeshi Kawamura
- Department of Nephrology, Toho University Faculty of Medicine, 6-11-1 Omori-Nishi, Ota-ku, Tokyo, 143-8541, Japan
| | - Nobuyuki Shiraga
- Department of Diagnostic Radiology, Toho University Omori Medical Center, Tokyo, Japan
| | - Takashi Yonekura
- Department of Nephrology, Toho University Faculty of Medicine, 6-11-1 Omori-Nishi, Ota-ku, Tokyo, 143-8541, Japan
| | - Maho Maeda
- Department of Nephrology, Toho University Faculty of Medicine, 6-11-1 Omori-Nishi, Ota-ku, Tokyo, 143-8541, Japan
| | - Sota Kurihara
- Department of Urology, National Hospital Organization Takasaki General Medical Center, Takasaki, Japan
| | - Yoshitaka Sekine
- Department of Urology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Seiichiro Shishido
- Department of Nephrology, Toho University Faculty of Medicine, 6-11-1 Omori-Nishi, Ota-ku, Tokyo, 143-8541, Japan
| | - Ken Sakai
- Department of Nephrology, Toho University Faculty of Medicine, 6-11-1 Omori-Nishi, Ota-ku, Tokyo, 143-8541, Japan
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Kaczmarek M, Halimi JM, de Fréminville JB, Gatault P, Gueguen J, Goin N, Longuet H, Barbet C, Bisson A, Sautenet B, Herbert J, Buchler M, Fauchier L. A Universal Bleeding Risk Score in Native and Allograft Kidney Biopsies: A French Nationwide Cohort Study. J Clin Med 2023; 12:jcm12103527. [PMID: 37240634 DOI: 10.3390/jcm12103527] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 04/24/2023] [Accepted: 04/28/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND The risk of bleeding after percutaneous biopsy in kidney transplant recipients is usually low but may vary. A pre-procedure bleeding risk score in this population is lacking. METHODS We assessed the major bleeding rate (transfusion, angiographic intervention, nephrectomy, hemorrhage/hematoma) at 8 days in 28,034 kidney transplant recipients with a kidney biopsy during the 2010-2019 period in France and compared them to 55,026 patients with a native kidney biopsy as controls. RESULTS The rate of major bleeding was low (angiographic intervention: 0.2%, hemorrhage/hematoma: 0.4%, nephrectomy: 0.02%, blood transfusion: 4.0%). A new bleeding risk score was developed (anemia = 1, female gender = 1, heart failure = 1, acute kidney failure = 2 points). The rate of bleeding varied: 1.6%, 2.9%, 3.7%, 6.0%, 8.0%, and 9.2% for scores 0 to 5, respectively, in kidney transplant recipients. The ROC AUC was 0.649 (0.634-0.664) in kidney transplant recipients and 0.755 (0.746-0.763) in patients who had a native kidney biopsy (rate of bleeding: from 1.2% for score = 0 to 19.2% for score = 5). CONCLUSIONS The risk of major bleeding is low in most patients but indeed variable. A new universal risk score can be helpful to guide the decision concerning kidney biopsy and the choice of inpatient vs. outpatient procedure both in native and allograft kidney recipients.
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Affiliation(s)
- Mathieu Kaczmarek
- Néphrologie-Immunologie Clinique, Hôpital Bretonneau, CHU Tours, F-37000 Tours, France
| | - Jean-Michel Halimi
- Néphrologie-Immunologie Clinique, Hôpital Bretonneau, CHU Tours, F-37000 Tours, France
- EA4245, University of Tours, F-37000 Tours, France
- INI-CRCT, F-54500 Nancy, France
| | - Jean-Baptiste de Fréminville
- Paris-Cardiovascular Research Center, INSERM, UMR970, Université de Paris, F-75006 Paris, France
- Unité Fonctionnelle d'Hypertension Artérielle, Centre de Référence des Maladies Rares de la Surrénale, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, F-75015 Paris, France
| | - Philippe Gatault
- Néphrologie-Immunologie Clinique, Hôpital Bretonneau, CHU Tours, F-37000 Tours, France
- EA4245, University of Tours, F-37000 Tours, France
| | - Juliette Gueguen
- Néphrologie-Immunologie Clinique, Hôpital Bretonneau, CHU Tours, F-37000 Tours, France
| | - Nicolas Goin
- Néphrologie-Immunologie Clinique, Hôpital Bretonneau, CHU Tours, F-37000 Tours, France
| | - Hélène Longuet
- Néphrologie-Immunologie Clinique, Hôpital Bretonneau, CHU Tours, F-37000 Tours, France
| | - Christelle Barbet
- Néphrologie-Immunologie Clinique, Hôpital Bretonneau, CHU Tours, F-37000 Tours, France
| | - Arnaud Bisson
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine, EA7505, Université de Tours, F-37000 Tours, France
| | - Bénédicte Sautenet
- Néphrologie-Immunologie Clinique, Hôpital Bretonneau, CHU Tours, F-37000 Tours, France
- INI-CRCT, F-54500 Nancy, France
| | - Julien Herbert
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine, EA7505, Université de Tours, F-37000 Tours, France
- Service d'Information Médicale, d'Épidémiologie et d'Économie de la Santé, Centre Hospitalier Universitaire et Faculté de Médecine, EA7505, Université de Tours, F-37000 Tours, France
| | - Matthias Buchler
- Néphrologie-Immunologie Clinique, Hôpital Bretonneau, CHU Tours, F-37000 Tours, France
- EA4245, University of Tours, F-37000 Tours, France
| | - Laurent Fauchier
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine, EA7505, Université de Tours, F-37000 Tours, France
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10
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Relvas M, Gonçalves J, Castro I, Diniz H, Mendonça L, Coentrão L. Effects of Aspirin on Kidney Biopsy Bleeding Complications: A Systematic Review and Meta-Analysis (PROSPERO 2021 CRD42021261005). KIDNEY360 2023; 4:700-710. [PMID: 36951435 PMCID: PMC10278841 DOI: 10.34067/kid.0000000000000091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 01/27/2023] [Indexed: 03/24/2023]
Abstract
Postprocedural bleeding is the main complication of percutaneous kidney biopsy (PKB). Therefore, aspirin is routinely withheld in patients undergoing PKB to reduce the bleeding risk. The authors aimed to examine the association between aspirin use and bleeding during PKB. This systematic review and meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The article search was performed on MEDLINE and Scopus using queries specific to each database. Article inclusion was limited to primary studies. The meta-analysis compared the risk of major bleeding events between the aspirin-exposed versus nonexposed group. Pooled effect estimate was examined using random effects presented as odds ratio with 95% confidence intervals. Heterogeneity was assessed through Cochrane I 2 test statistics. Sensitivity and subgroup analyses were also performed according to kidney type. Ten studies were included in the review and four studies were included in the meta-analysis, reviewing a total of 34,067 PKBs. Definitions for significant aspirin exposure were inconsistent between studies, limiting comparisons. Studies with broader definitions for aspirin exposure mostly showed no correlation between aspirin use and postbiopsy bleeding. Studies with strict definitions for aspirin exposure found an increased risk of hemorrhagic events in the aspirin-exposed group. No significant differences were found between the aspirin-exposed and comparison groups regarding major bleeding events (odds ratio 1.72; 95% confidence interval 0.50 to 5.89, I 2 =84%). High-quality evidence on the effect of aspirin on the bleeding risk is limited. Our meta-analysis did not show a significantly increased risk of major bleeding complications in aspirin-exposed patients. Further studies are needed to define a more comprehensive approach for clinical practice.
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Affiliation(s)
- Miguel Relvas
- Nephrology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Joana Gonçalves
- Department of Medicine, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Inês Castro
- Department of Medicine, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Hugo Diniz
- Nephrology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Luís Mendonça
- Nephrology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
- Department of Surgery and Physiology, UnIC@RISE, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Luís Coentrão
- Nephrology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
- Department of Medicine, Faculty of Medicine, University of Porto, Porto, Portugal
- Nephrology & Infectious Diseases R&D, i3S—Institute for Research & Innovation in Health, Porto, Portugal
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11
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Gandhi DB, Al Saeedi M, Krier JD, Jiang K, Glockner JF, Lerman LO. Evaluation of Renal Fibrosis Using Magnetization Transfer Imaging at 1.5T and 3T in a Porcine Model of Renal Artery Stenosis. J Clin Med 2023; 12:jcm12082956. [PMID: 37109291 PMCID: PMC10140905 DOI: 10.3390/jcm12082956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 04/13/2023] [Accepted: 04/15/2023] [Indexed: 04/29/2023] Open
Abstract
Renal fibrosis is an important marker in the progression of chronic kidney disease, and renal biopsy is the current reference standard for detecting its presence. Currently, non-invasive methods have only been partially successful in detecting renal fibrosis. Magnetization transfer imaging (MTI) allows estimates of renal fibrosis but may vary with scanning conditions. We hypothesized that MTI-derived renal fibrosis would be reproducible at 1.5T and 3T MRI and over time in fibrotic kidneys. Fifteen pigs with unilateral renal artery stenosis (RAS, n = 9) or age-matched sham controls (n = 6) underwent MTI-MRI at both 1.5T and 3T 6 weeks post-surgery and again 4 weeks later. Magnetization transfer ratio (MTR) measurements of fibrosis in both kidneys were compared between 1.5T and 3T, and the reproducibility of MTI at the two timepoints was evaluated at 1.5T and 3T. MTR at 3T with 600 Hz offset frequency successfully distinguished between normal, stenotic, and contralateral kidneys. There was excellent reproducibility of MTI at 1.5T and 3T over the two timepoints and no significant differences between MTR measurements at 1.5T and 3T. Therefore, MTI is a highly reproducible technique which is sensitive to detect changes in fibrotic compared to normal kidneys in the RAS porcine model at 3T.
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Affiliation(s)
- Deep B Gandhi
- Division of Nephrology and Hypertension, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Mina Al Saeedi
- Division of Nephrology and Hypertension, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - James D Krier
- Division of Nephrology and Hypertension, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Kai Jiang
- Division of Nephrology and Hypertension, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - James F Glockner
- Department of Diagnostic Radiology, Mayo Clinic, Rochester, MN 55905, USA
| | - Lilach O Lerman
- Division of Nephrology and Hypertension, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
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12
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Lee O, Kim MJ, Lee JE, Kwon GY, Hwang NY, Kim K, Park JB, Lee KW. Effects of Treating Subclinical Rejection 2 Weeks After Kidney Transplantation, as Determined by Analyzing 1-Year Histologic Outcomes. Transplant Proc 2023:S0041-1345(23)00129-X. [PMID: 37062613 DOI: 10.1016/j.transproceed.2023.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 03/13/2023] [Indexed: 04/18/2023]
Abstract
Subclinical rejection (SCR) is associated with chronic allograft nephropathy. Therefore, early detection and treatment of SCR through a protocol biopsy (PB) can reduce the incidence of pathologic changes. This study evaluates the impact of early detection and treatment of SCR using a routine PB 2 weeks after kidney transplantation (KT) by examining histologic outcomes 1 year later. We reviewed 624 KT recipients at the Samsung Medical Center between August 2012 and December 2018. Protocol biopsy was planned 2 weeks and 1 year after transplantation. We compared the histologic changes between the 2 biopsies. After a propensity score matching analysis, we divided the patients into 2 groups: the proven normal group (n = 256) and the rejection group (n = 96) at the PB taken 2 weeks post-transplant. The rejection group showed no significant difference from the normal group in the flow of graft function or the Kaplan-Meier curve for graft survival. In the histologic outcomes, the pathologic differences between the groups significantly improved between the 2 time points. Treating SCR through a PB 2 weeks after KT can contribute to the maintenance of graft function and improve histologic changes 1 year after KT.
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Affiliation(s)
- Okjoo Lee
- Department of Surgery, Soonchunhyang University Hospital Bucheon, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea
| | - Min Jung Kim
- Department of Surgery, Seoul Medical Center, Seoul, Republic of Korea
| | - Jung Eun Lee
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ghee Young Kwon
- Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Na Young Hwang
- Statistics and Data Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - Kyunga Kim
- Statistics and Data Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - Jae Berm Park
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
| | - Kyo Won Lee
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
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13
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Lee O, Kim MJ, Lee JE, Hwang NY, Kim K, Lee KW, Park JB. The Protective Role of Protocol Biopsy for Allograft Kidney Maintenance in Kidney Transplantation. Transplant Proc 2023:S0041-1345(23)00095-7. [PMID: 36990887 DOI: 10.1016/j.transproceed.2023.01.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 01/04/2023] [Indexed: 03/29/2023]
Abstract
Many studies have reported that protocol biopsy (PB) may help preserve kidney function in kidney transplant recipients. Early detection and treatment of subclinical rejection may reduce the incidence of chronic antibody-mediated rejection and graft failure. However, no consensus has been reached regarding PB effectiveness, timing, and policy. This study aimed to evaluate the protective role of routine PB performed 2 weeks and 1 year after kidney transplantation. We reviewed 854 kidney transplant recipients at the Samsung Medical Center between July 2007 and August 2017, with PBs planned at 2 weeks and 1 year after transplantation. We compared the trends in graft function, chronic kidney disease (CKD) progression, new-onset CKD, infection, and patient and graft survival between the 504 patients who underwent PB and 350 who did not undergo PB. The PB group was again divided into 2 groups: the single PB group (n = 207) and the double PB group (n = 297). The PB group was significantly different from the no-PB group in terms of the trends in graft function (estimated glomerular filtration rate). The Kaplan-Meier curve showed that PB did not significantly improve graft or overall patient survival. However, in the multivariate Cox analysis, the double PB group had advantages in graft survival, CKD progression, and new-onset CKD. PB can play a protective role in the maintenance of kidney grafts in kidney transplant recipients.
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14
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Moein M, Papa S, Ortiz N, Saidi R. Protocol Biopsy After Kidney Transplant: Clinical Application and Efficacy to Detect Allograft Rejection. Cureus 2023; 15:e34505. [PMID: 36874304 PMCID: PMC9983784 DOI: 10.7759/cureus.34505] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2023] [Indexed: 02/04/2023] Open
Abstract
Background Kidney transplant rejection is a major cause of graft dysfunction and failure. In recent years, there has been increased interest in renal allograft protocol biopsies to allow earlier detection of acute or chronic graft dysfunction or rejection to improve long-term graft survival and reduce graft failure. This study aimed to determine if renal allograft protocol biopsies performed within the first 12 months after transplantation help detect subclinical graft dysfunction or rejection. Methods We performed a retrospective analysis utilizing SUNY Upstate University Hospital data from January 2016 to March 2022 to assess transplant outcomes and biopsies. The study population was divided into two subgroups: non-protocol biopsies and protocol biopsies within the 12 months post-transplant. Results A total of 332 patients met our inclusion criteria and were included in the study. Patients were divided into two subgroups: 135 patients (40.6%) in the protocol biopsy group and 197 patients (59.4%) with non-protocol indication biopsies during the first year after the transplant. The overall number of rejection episodes reported was eight episodes (4.6%) in the protocol biopsy group and 56 episodes (18.3%) in the non-protocol indication biopsy group, which was significantly higher in the non-protocol biopsy group (P=0.001). Antibody-mediated rejection (ABMR) and T-cell-mediated rejection (TCMR) diagnoses were significantly higher in the non-protocol biopsy group (P=0.03 and P=0.03, respectively). We also mentioned a trend in terms of mixed antibody-mediated rejection and T-cell-mediated rejection diagnosis (P=0.07). One year after the rejection, the mean glomerular filtration rate (GFR) was 56.78 mL/min/1.73m2 in the protocol biopsy group and 49.14 mL/min/1.73m2 in the non-protocol indication biopsy group, and there was no significant difference anymore (P=0.11). The patient survival rate was not significantly higher in the protocol biopsy group compared to the non-protocol indication biopsy group (P=0.42). Conclusion This study suggests that performing protocol biopsies does not significantly benefit rejection rates, graft survival, or renal function within the first 12 months post-transplant. Given these results and the small but non-zero risk of complications associated with protocol biopsies, they should be reserved for those patients at high risk of rejection. It may be more feasible and beneficial to utilize less invasive tests, such as DSA and dd-cfDNA testing, for early diagnosis of a rejection episode.
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Affiliation(s)
- Mahmoudreza Moein
- Transplantation Services, Upstate University Hospital, Syracuse, USA
| | - Sarah Papa
- Transplantation Services, Upstate University Hospital, Syracuse, USA
| | - Noelle Ortiz
- Transplantation Services, Upstate University Hospital, Syracuse, USA
| | - Reza Saidi
- Transplantation Services, Upstate University Hospital, Syracuse, USA
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15
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Kumar KV, Sathyan J, Prasannan M, Urs V, Prasannan B, Unni VN. Utility of protocol biopsy in the management of renal allograft recipients. INDIAN JOURNAL OF TRANSPLANTATION 2023. [DOI: 10.4103/ijot.ijot_50_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
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16
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Bouchet A, Muller B, Olagne J, Barba T, Joly M, Obrecht A, Rabeyrin M, Dijoud F, Picard C, Mezaache S, Sicard A, Koenig A, Parissiadis A, Dubois V, Morelon E, Caillard S, Thaunat O. Evolution of humoral lesions on follow-up biopsy stratifies the risk for renal graft loss after antibody-mediated rejection treatment. Nephrol Dial Transplant 2022; 37:2555-2568. [PMID: 35675302 DOI: 10.1093/ndt/gfac192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The standard-of-care protocol, based on plasma exchanges, high-dose intravenous immunoglobulin and optimization of maintenance immunosuppression, can slow down the evolution of antibody-mediated rejection (AMR), but with high interindividual variability. Identification of a reliable predictive tool of the response to AMR treatment is a mandatory step for personalization of the follow-up strategy and to guide second-line therapies. METHODS Interrogation of the electronic databases of 2 French university hospitals (Lyon and Strasbourg) retrospectively identified 81 renal transplant recipients diagnosed with AMR without chronic lesions (cg score ≤1) at diagnosis and for whom a follow-up biopsy had been performed 3-6 months after initiation of therapy. RESULTS The evolution of humoral lesions on follow-up biopsy (disappearance versus persistence versus progression) correlated with the risk for allograft loss (logrank test, P = .001). Patients with disappearance of humoral lesions had ∼80% graft survival at 10 years. The hazard ratio for graft loss in multivariate analysis was 3.91 (P = .04) and 5.15 (P = .02) for patients with persistence and progression of lesions, respectively. The non-invasive parameters classically used to follow the intensity of humoral alloimmune response (evolution of immunodominant DSA mean fluorescence intensity) and the decline of renal graft function (estimated glomerular filtration rate decrease and persistent proteinuria) showed little clinical value to predict the histological response to AMR therapy. CONCLUSION We conclude that invasive monitoring of the evolution of humoral lesions by the mean of follow-up biopsy performed 3-6 months after the initiation of therapy is an interesting tool to predict long-term outcome after AMR treatment.
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Affiliation(s)
- Antonin Bouchet
- Service de Transplantation, Néphrologie et Immunologie Clinique, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France.,Unité de Formation et de Recherche de Médecine Lyon Est, Université Claude-Bernard Lyon I, Lyon, France
| | - Brieuc Muller
- Service de Néphrologie et Transplantation, Les Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Jerome Olagne
- Service de Néphrologie et Transplantation, Les Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Thomas Barba
- Unité de Formation et de Recherche de Médecine Lyon Est, Université Claude-Bernard Lyon I, Lyon, France.,Institut National de la Santé et de la Recherche Médicale U1111, Lyon, France
| | - Mélanie Joly
- Service de Néphrologie et Transplantation, Les Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Augustin Obrecht
- Service de Néphrologie et Transplantation, Les Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Maud Rabeyrin
- Institut de Pathologie Multisite, Groupement Hospitalier Est, Bron, France
| | - Frédérique Dijoud
- Institut de Pathologie Multisite, Groupement Hospitalier Est, Bron, France
| | - Cécile Picard
- Institut de Pathologie Multisite, Groupement Hospitalier Est, Bron, France
| | - Sarah Mezaache
- Service de Transplantation, Néphrologie et Immunologie Clinique, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France.,Unité de Formation et de Recherche de Médecine Lyon Est, Université Claude-Bernard Lyon I, Lyon, France
| | - Antoine Sicard
- Service de Transplantation, Néphrologie et Immunologie Clinique, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France.,Unité de Formation et de Recherche de Médecine Lyon Est, Université Claude-Bernard Lyon I, Lyon, France
| | - Alice Koenig
- Service de Transplantation, Néphrologie et Immunologie Clinique, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France.,Unité de Formation et de Recherche de Médecine Lyon Est, Université Claude-Bernard Lyon I, Lyon, France.,Institut National de la Santé et de la Recherche Médicale U1111, Lyon, France
| | - Anne Parissiadis
- Laboratoire d'Histocompatibilité, Etablissement Français du Sang, Strasbourg, France
| | - Valérie Dubois
- Institut National de la Santé et de la Recherche Médicale U1111, Lyon, France.,Laboratoire d'Histocompatibilité, Etablissement Français du Sang, Lyon, France
| | - Emmanuel Morelon
- Service de Transplantation, Néphrologie et Immunologie Clinique, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France.,Unité de Formation et de Recherche de Médecine Lyon Est, Université Claude-Bernard Lyon I, Lyon, France.,Institut National de la Santé et de la Recherche Médicale U1111, Lyon, France
| | - Sophie Caillard
- Service de Néphrologie et Transplantation, Les Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Olivier Thaunat
- Service de Transplantation, Néphrologie et Immunologie Clinique, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France.,Unité de Formation et de Recherche de Médecine Lyon Est, Université Claude-Bernard Lyon I, Lyon, France.,Institut National de la Santé et de la Recherche Médicale U1111, Lyon, France
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17
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Metabolomic Profiling of Plasma, Urine, and Saliva of Kidney Transplantation Recipients. Int J Mol Sci 2022; 23:ijms232213938. [PMID: 36430414 PMCID: PMC9695205 DOI: 10.3390/ijms232213938] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 11/05/2022] [Accepted: 11/08/2022] [Indexed: 11/16/2022] Open
Abstract
Kidney biopsy is commonly used to diagnose kidney transplant dysfunction after transplantation. Therefore, the development of minimally invasive and quantitative methods to evaluate kidney function in transplant recipients is necessary. Here, we used capillary electrophoresis-mass spectrometry to analyze the biofluids collected from transplant recipients with impaired (Group I, n = 31) and stable (Group S, n = 19) kidney function and from donors (Group D, n = 9). Metabolomics analyses identified and quantified 97 metabolites in plasma, 133 metabolites in urine, and 108 metabolites in saliva. Multivariate analyses revealed apparent differences in the metabolomic profiles of the three groups. In plasma samples, arginine biosynthesis and purine metabolism between the I and S Groups differed. In addition, considerable differences in metabolomic profiles were observed between samples collected from participants with T cell-mediated rejection (TCR), antibody-mediated rejection, and other kidney disorders (KD). The metabolomic profiles in the three types of biofluids showed different patterns between TCR and KD, wherein 3-indoxyl sulfate showed a significant increase in TCR consistently in both plasma and urine samples. These results suggest that each biofluid has different metabolite features to evaluate kidney function after transplantation and that 3-indoxyl sulfate could predict acute rejection.
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18
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Intravoxel Incoherent Motion-Diffusion-Weighted MRI for Investigation of Delayed Graft Function Immediately after Kidney Transplantation. BIOMED RESEARCH INTERNATIONAL 2022; 2022:2832996. [PMID: 36303584 PMCID: PMC9596237 DOI: 10.1155/2022/2832996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 09/02/2022] [Accepted: 09/12/2022] [Indexed: 11/17/2022]
Abstract
Purpose A non-invasive way of assessing post-transplant renal graft function has been needed. This study aimed to assess the micro-structural and micro-functional status of graft kidneys by using intravoxel incoherent motion- (IVIM-) diffusion-weighted imaging (DWI) to investigate delayed graft function (DGF) immediately after transplantation. Method A prospective study was conducted on 37 patients, 14 with early graft function (EGF) and 23 with DGF (9 with complication, 14 without) who underwent IVIM-DWI, most often within 1-7 days after kidney transplantation. A total of 37 cases were collected and all the participants have been well-informed and signed their consents. In addition, the study conducted in this paper was approved by the Ethics Committee of Clinical Research, Taichung Veterans General Hospital (IRB number: CE14065). Using biexponential analysis of slow diffusion coefficient (Dslow), fast diffusion coefficient (Dfast), and perfusion fraction was performed. The apparent diffusion coefficient (ADC) was calculated by use of a monoexponential model. All parameters were measured from three different regions-of-interest (ROI), covering the entire renal parenchyma, cortex, and medulla. Results Dslow, perfusion fraction, and ADC were significantly higher in patients with EGF than DGF (all p values values <0.001). Especially, ADC measured from ROI covering the entire kidney parenchyma had the best cut-off value (1.93μm2/msec) with the highest area under the receiver operating characteristic curve (AUC 0.943) in differentiating EGF from DGF. For analysis of pair-wise differences, only the perfusion fraction values, measured from the ROI covering the renal cortex, were significantly higher in 14 DGF patients with no complications than in the 9 DGF patients with complications, with the best cut-off value of 12.3% and the AUC of 0.844. Conclusion Noninvasive IVIM-DWI reliably differentiates DGF from EGF after kidney transplantation, and it may aid in identifying posttransplant complications and indications for renal biopsy.
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19
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Santana Quintana CA, Gallego Samper R, Santana Estupiñán R, Aladro Escribano S, Medina García D, Daruiz D`Orazio Y, Quevedo Reina J, González Cabrera F, Vega Díaz N, Pérez Borges P. Experience and Utility of the Protocol Kidney Biopsy in the First Year of Kidney Transplantation. Transplant Proc 2022; 54:2443-2445. [DOI: 10.1016/j.transproceed.2022.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 09/22/2022] [Accepted: 10/01/2022] [Indexed: 11/05/2022]
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20
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Mattiazzi AD, Cortesi CA, Patil RJ, Carias Martinez KG, Sedki M, Cabeza Rivera FH, Ruiz P, Salsamendi JT, Guerra G. Percutaneous Ultrasound-Guided Kidney Transplant Biopsy Outcomes: From the Nephrologist to the Radiologist Standpoint. KIDNEY360 2022; 3:1746-1753. [PMID: 36514719 PMCID: PMC9717654 DOI: 10.34067/kid.0000332022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 08/02/2022] [Indexed: 01/28/2023]
Abstract
Background Kidney transplant biopsies are the gold standard for evaluating allograft dysfunction. These biopsies are performed by nephrologists and radiologists under real-time ultrasound guidance. A few studies have examined the outcomes of ultrasound-guided kidney transplant biopsy in transplant recipients; however, none have compared these outcomes between both specialties. Methods We retrospectively analyzed a cohort of 678 biopsies performed in a single center during a 44-month study period. Biopsies were stratified into two groups based upon the specialist performing the procedure: interventional radiology (IR; N=447) and transplant nephrology (TN; N=231). Results There were 55 (8%) complications related to biopsies in the entire cohort: 37 (8.2%) in the IR group and 18 (7.7%) in the TN group, without statistical difference between the groups (P=0.94). Blood pressure control and prior use of anticoagulation were significant predictors of complicated biopsies (P=0.004 and 0.02, respectively). Being a woman and prior use of anticoagulation were significant predictors of transfusion of blood products (P=0.01 and 0.01, respectively). Being a woman and blood pressure control were significant predictors of overall perinephric hematoma (P=0.01 and 0.01, respectively), and Black race was a significant predictor of perinephric hematoma without worsening of renal function (P=0.005). The specialist team performing the procedure was not a statistically significant predictor of biopsy complications, transfusion of blood products, or perinephric hematoma with comparable sample yield. Conclusions Percutaneous ultrasound-guided kidney transplant biopsy performed by transplant nephrologists have similar complication rates when compared with interventional radiologists in an academic center.
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Affiliation(s)
- Adela D. Mattiazzi
- Katz Family Division of Nephrology and Hypertension, University of Miami Miller School of Medicine, Miami, Florida,Miami Transplant Institute, University of Miami/Jackson Memorial Hospital, Miami, Florida
| | - Camilo A. Cortesi
- Department of Medicine, Division of Nephrology, University of California, San Francisco, California
| | - Rhea J. Patil
- School of Medicine, University of Miami, Miami, Florida
| | - Karla G. Carias Martinez
- Department of Medicine, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, Florida
| | - Mai Sedki
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California
| | - Franco H. Cabeza Rivera
- Department of Medicine, Division of Nephrology, University of Mississippi, Oxford, Mississippi
| | - Phillip Ruiz
- Miami Transplant Institute, University of Miami/Jackson Memorial Hospital, Miami, Florida,Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Jason T. Salsamendi
- Department of Interventional Radiology, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, Florida
| | - Giselle Guerra
- Katz Family Division of Nephrology and Hypertension, University of Miami Miller School of Medicine, Miami, Florida,Miami Transplant Institute, University of Miami/Jackson Memorial Hospital, Miami, Florida
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21
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Ho QY, Lim CC, Tan HZ, Sultana R, Kee T, Htay H. Complications of Percutaneous Kidney Allograft Biopsy: Systematic Review and Meta-analysis. Transplantation 2022; 106:1497-1506. [PMID: 35019898 DOI: 10.1097/tp.0000000000004033] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Kidney biopsy is important to guide the management of allograft dysfunction but has a risk of complications. This review aimed to determine the incidence and risk factors of complications after kidney allograft biopsy. METHODS This is a systematic review and meta-analysis of randomized controlled trials, cohort studies, or case-control studies indexed on PubMed, Embase, Cochrane Central Register of Controlled Trials, World Health Organization International Clinical Trials Registry, and ClinicalTrials.gov, limited to the English language, from January 2000 to December 2020, including adult and pediatric kidney allograft biopsies. Primary outcomes were gross hematuria, bleeding requiring transfusion, and major complications (requiring interventions such as blood transfusion or surgical or radiological interventions). RESULTS The review included 72 studies (40 082 biopsies). The quality of included studies was suboptimal. Pooled rates of gross hematuria, bleeding requiring transfusion, and major complications were 3.18% [95% confidence interval (95% CI), 2.31-4.19], 0.31% (95% CI, 0.15-0.52) and 0.89% (95% CI, 0.61-1.22), respectively. Gross hematuria rates were lower in high-income compared with middle-income countries (2.59% versus 6.44%, P < 0.01) and biopsies performed by radiology as compared with nephrology departments (1.25% versus 3.71%, P < 0.01). Blood transfusion rates were lower in pediatrics than adults (0.0% versus 0.65%, P < 0.01). Major complications were lower in biopsies performed by specialists as compared with trainees (0.02% versus 3.64%, P < 0.01). Graft loss and mortality were extremely rare. Limitations included missing data, few randomized controlled trials, and possible publication bias. CONCLUSIONS The risk of complications after kidney allograft biopsy was low. Given the low quality of included studies, risk factors for complications should be further examined in future studies.
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Affiliation(s)
- Quan Yao Ho
- Department of Renal Medicine, Singapore General Hospital, Singapore
- SingHealth Duke-NUS Transplant Centre, Singapore
| | | | - Hui Zhuan Tan
- Department of Renal Medicine, Singapore General Hospital, Singapore
| | | | - Terence Kee
- Department of Renal Medicine, Singapore General Hospital, Singapore
- SingHealth Duke-NUS Transplant Centre, Singapore
| | - Htay Htay
- Department of Renal Medicine, Singapore General Hospital, Singapore
- Duke-NUS Medical School, Singapore
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22
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Dillman JR, Benoit SW, Gandhi DB, Trout AT, Tkach JA, VandenHeuvel K, Devarajan P. Multiparametric quantitative renal MRI in children and young adults: comparison between healthy individuals and patients with chronic kidney disease. Abdom Radiol (NY) 2022; 47:1840-1852. [PMID: 35237897 DOI: 10.1007/s00261-022-03456-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 02/11/2022] [Accepted: 02/14/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE Multiparametric quantitative renal MRI may provide noninvasive radiologic biomarkers of chronic kidney disease (CKD) based on investigations in animal models and adults. We aimed to (1) obtain normative multiparametric quantitative MRI data from the kidneys of healthy children and young adults, (2) compare MRI measurements between healthy control participants and patients with CKD, and (3) determine if MRI measurements correlate with clinical and laboratory data as well as histology. METHODS This was a prospective, case-control study of 20 healthy controls and 12 CKD patients who underwent percutaneous renal biopsy ranging from 12 to 23 years of age between October 2018 and March 2020. Kidney function was documented and pathology assessed for fibrosis/inflammation. Utilizing a field strength of 1.5T, we examined renal T1, T2, and T2* relaxation mapping, MR elastography (MRE), and diffusion-weighted imaging (DWI). A single analyst made all manual measurements for quantitative MRI pulse sequences. Independent measurements from cortex, medulla, and whole kidney were obtained by drawing regions of interest on single slices from the upper, mid, and lower kidney. A weighted average was calculated for each kidney; if two kidneys, the right and left were averaged. Continuous variables were compared with Mann-Whitney U test; bivariate relationships were assessed using Spearman rank-order correlation. RESULTS Median estimated glomerular filtration rate (eGFR) was 112.3 ml/min/1.73 m2 in controls (n = 20, 10 females) and 55.0 ml/min/m2 in CKD patients (n = 12, 2 females) (p < 0.0001). Whole kidney (1333 vs. 1291 ms; p = 0.018) and cortical (1212 vs 1137 ms; p < 0.0001) T1 values were higher in CKD patients. Cortical T1 values correlated with eGFR (rho = - 0.62; p = 0.0003) and cystatin C (rho = 0.58; p = 0.0007). Whole kidney (1.87 vs. 2.02 10-3 mm2/s; p = 0.007), cortical (1.89 vs. 2.04 10-3 mm2/s; p = 0.008), and medullary (1.87 vs. 1.98 10-3 mm2/s; p = 0.0095) DWI apparent diffusion coefficients (ADC) were lower in CKD patients. Whole kidney ADC correlated with eGFR (rho = 0.45; p = 0.012) and cystatin C (rho = - 0.46; p = 0.009). Cortical histologic inflammation correlated with DWI ADC (rho = - 0.71; p = 0.011). CONCLUSION Renal T1 relaxation and DWI ADC measurements differ between pediatric healthy controls and CKD patients, correlate with laboratory markers of CKD, and may have histologic correlates.
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Affiliation(s)
- Jonathan R Dillman
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45244, USA.
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| | - Stefanie W Benoit
- Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Deep B Gandhi
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45244, USA
| | - Andrew T Trout
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45244, USA
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Jean A Tkach
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45244, USA
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Katherine VandenHeuvel
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Division of Pathology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pathology and Laboratory Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Prasad Devarajan
- Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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23
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Lim M, Park BK, Lee KW, Park JB, Kim KD, Yang J, Kwon J, Jeong ES, Lee S. Two-Week Protocol Biopsy in Renal Allograft: Feasibility, Safety, and Outcomes. J Clin Med 2022; 11:jcm11030785. [PMID: 35160237 PMCID: PMC8836907 DOI: 10.3390/jcm11030785] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 01/27/2022] [Accepted: 01/29/2022] [Indexed: 01/20/2023] Open
Abstract
Background: Protocol biopsy in renal allograft helps to early detect subclinical rejection (SCR) in patients who have no abnormal clinical and laboratory findings. Still, there are rare reports about the techniques and outcomes of two-week protocol biopsy. The aim of this study was to assess two-week protocol biopsy regarding the technical feasibility, procedure safety, and clinical outcomes. Methods: A total of 894 protocol biopsies were performed in adult recipients between 2012 and 2019. Two-week and one-year protocol biopsies were guided with ultrasound in 842 and 399 patients by one of four radiologists with wide range of biopsy experience, respectively. These protocol biopsies were compared in terms of feasibility and safety. Standard references were clinico-laboratory findings and biopsy examinations. Results: The median period of two-week and one-year protocol biopsies were 12 days (10–20 days) and 383 days (302–420 days), respectively. All protocol biopsies were technically successful and there was no difference between radiologists regarding technical success and complications (p = 0.453). Major complication (Clavien–Dindo grading II–IV) rates of two-week and one-year protocol biopsies were 0.3% (3/842) and 0.2% (1/399), respectively (p = 1.000). However, univariate analysis demonstrated that platelet count < 100 K/mL and blood urea nitrogen ≥ 40 mg/dL were associated with major complications in two-week protocol biopsy. The SCRs of these protocol biopsies were 15.4% (130/842) and 33.6% (134/399), respectively (p < 0.001). Conclusion: Two-week protocol biopsy is technically feasible and safe. It contributes to early detecting a substantial number of SCRs. Prior to the biopsy, platelet count and blood urea nitrogen should be carefully checked to predict major complications.
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Affiliation(s)
- Manuel Lim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (M.L.); (J.B.P.); (K.D.K.); (J.Y.); (J.K.); (E.S.J.)
| | - Byung Kwan Park
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
- Correspondence: (B.K.P.); (K.W.L.); Tel.: +82-2-3410-6457 (B.K.P.); +82-10-9933-5192 (K.W.L.); Fax: +82-2-3410-0084 (B.K.P.)
| | - Kyo Won Lee
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (M.L.); (J.B.P.); (K.D.K.); (J.Y.); (J.K.); (E.S.J.)
- Correspondence: (B.K.P.); (K.W.L.); Tel.: +82-2-3410-6457 (B.K.P.); +82-10-9933-5192 (K.W.L.); Fax: +82-2-3410-0084 (B.K.P.)
| | - Jae Berm Park
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (M.L.); (J.B.P.); (K.D.K.); (J.Y.); (J.K.); (E.S.J.)
| | - Kyeong Deok Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (M.L.); (J.B.P.); (K.D.K.); (J.Y.); (J.K.); (E.S.J.)
| | - Jaehun Yang
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (M.L.); (J.B.P.); (K.D.K.); (J.Y.); (J.K.); (E.S.J.)
| | - Jieun Kwon
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (M.L.); (J.B.P.); (K.D.K.); (J.Y.); (J.K.); (E.S.J.)
| | - Eun Sung Jeong
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (M.L.); (J.B.P.); (K.D.K.); (J.Y.); (J.K.); (E.S.J.)
| | - Seunghwan Lee
- Department of Surgery, Kyung Hee University Hospital at Gangdong, Seoul 05278, Korea;
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24
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Pirklbauer M, Berger M, Boban MD, Tiefenthaler M. The Tangential Extraperitoneal Retrorenal Approach in Kidney Transplant Biopsy: An Observational Study to Assess Complication and Adequacy Rates. Transpl Int 2022; 35:10068. [PMID: 35185363 PMCID: PMC8842347 DOI: 10.3389/ti.2021.10068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 12/21/2021] [Indexed: 01/20/2023]
Abstract
Introduction: Ultrasound-guided percutaneous kidney allograft biopsy is the gold-standard for pathology work-up. Recent studies postulate better safety and efficacy for tangential approaches, however, there is no recommendation regarding biopsy needle path. In this context, we previously described the unified tangential extraperitoneal retrorenal (TER) approach for standard allograft biopsy. Methods: A single-center retrospective observational study evaluated safety and efficacy of the TER biopsy approach among 250 patients that underwent 330 ultrasound-guided kidney transplant biopsies between January 2011 and May 2020. Results: The overall major complication rate was 0.56% per biopsy attempt (1.21% per biopsy) including blood transfusion, arterial embolization and bladder catheterization for gross hematuria in 0.28, 0.14 and 0.14% of biopsy attempts, respectively (0.61, 0.30 and 0.30% of biopsies, respectively). Minor complications included subcapsular and/or perinephric hematoma, superficial bleeding, arteriovenous fistula and gross hematuria in 12.6, 3.0, 2.5 and 1.4% of biopsy attempts, respectively (27.0, 6.4, 5.5 and 3.0% of biopsies, respectively). Sample adequacy rate was 86.7%, ranging from 82.2 to 94.1% if one or ≥two cores were analyzed, respectively. Residents and consultants yielded similar complication and adequacy rates. Conclusion: According to current literature, ultrasound-guided TER kidney transplant biopsy is a safe and efficient approach eligible for nephrology training.
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25
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Yatim KM, Azzi JR. Novel Biomarkers in Kidney Transplantation. Semin Nephrol 2022; 42:2-13. [DOI: 10.1016/j.semnephrol.2022.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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26
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Lymphocyte function based on IFN-γ secretion assay may be a promising indicator for assessing different immune status in renal transplant recipients. Clin Chim Acta 2021; 523:247-259. [PMID: 34626603 DOI: 10.1016/j.cca.2021.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 10/02/2021] [Accepted: 10/04/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Immunological monitoring plays a crucial role in organ recipients for allowing tailoring of immunosuppression. However, there is still a paucity of promising indicators for detecting immune status in recipients. METHODS We conducted a prospective study to characterize the immune status by detecting dynamically lymphocyte subsets and function (represented by the abilities to secrete IFN-γ) in the first 6 months posttransplant in renal recipients. Participants were classified into an immune stable group, infected group, and rejected group. RESULTS In the stable group, our study suggested that the counts and function of CD4+ T, CD8+ T, and NK lymphocytes decreased to their nadir at week 2, and thereafter these indicators were gradually restored. The counts exceeded pre-operative levels, whereas function did not reach the pre-transplant levels by 6 months. We demonstrated that function of lymphocytes was considerably decreased in infected recipients compared with the stable group when infection occurred. By contrast, the function of lymphocytes was obviously increased at the point of rejection. Receiver operating characteristic (ROC) analysis in the combination of subsets and function of lymphocytes presented a superior clinical value with an area under the curve (AUC) of 0.903 in the diagnosis of infected receivers, and IFN-γ+CD8+ T cells% is the highest indicator with the auROC curve of 0.862. Another ROC analysis confirmed that IFN-γ+CD4 T cells% presented a preferable diagnostic value with an area of 0.887 for rejected recipients. CONCLUSIONS In conclusion, the ability of lymphocyte subsets secreting IFN-γ may provide a promising assessment of immune status in recipients and allow timely modifying immunosuppression.
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27
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Peters B, Afghahi H, Maitlo S, Hadimeri H. Risk factors for biopsy complications in initial versus subsequent biopsies in native and transplant kidneys. Acta Radiol 2021; 62:1426-1432. [PMID: 33095648 DOI: 10.1177/0284185120966687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Few studies exist about risk factors for complications in subsequent biopsies. PURPOSE To explore risk factors for complications in initial versus subsequent biopsies in native and transplant kidneys, which may predict biopsy complications. MATERIAL AND METHODS In a multicenter study, 2830 native kidney biopsies (4.3% subsequent) were analyzed for major complications (1251 of these were also analyzed for minor) and 667 transplant kidney biopsies (29% subsequent) were analyzed for major and minor complications. No death or nephrectomy were described. Fisher's exact test, Student's t-test, chi-square analyses, and univariate and multiple binary logistic regression analyses were employed; P < 0.05 was considered significant. RESULTS In initial native kidney biopsies, the frequency of major complications was higher in women compared to men (odds ratio 1.6, 95% confidence interval 1.1-2.2), in younger patients (50 vs. 54 years, P = 0.007), and in patients with lower weight (78 vs. 82 kg, P = 0.005). In subsequent native kidney biopsies, patients with major complications had a higher systolic blood pressure (145 vs. 132 mmHg, P = 0.03). In initial transplant kidney biopsies, biopsies with major complications had less glomeruli in the biopsy (17 vs. 24, P = 0.046). In subsequent transplant kidney biopsies, patients with major complications had a higher mean arterial pressure (112 vs. 98 mmHg, P = 0.002). In subsequent native kidney biopsies, there was a higher number of SLE-nephritis (12% vs. 4.6%, P = 0.001) compared to initial biopsies. CONCLUSION The different types of risk factors for complications in initial versus subsequent renal biopsies could be important for the clinicians to improve patients' safety.
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Affiliation(s)
- Björn Peters
- Department of Nephrology, Skaraborg Hospital, Skövde, Sweden
- Department of Molecular and Clinical Medicine, Institute of Medicine, the Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Henri Afghahi
- Department of Nephrology, Skaraborg Hospital, Skövde, Sweden
| | - Salar Maitlo
- Department of Nephrology, Skaraborg Hospital, Skövde, Sweden
| | - Henrik Hadimeri
- Department of Nephrology, Skaraborg Hospital, Skövde, Sweden
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28
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Jang HR, Kim M, Hong S, Lee K, Park MY, Yang KE, Lee CJ, Jeon J, Lee KW, Lee JE, Park JB, Kim K, Kwon GY, Kim YG, Kim DJ, Huh W. Early postoperative urinary MCP-1 as a potential biomarker predicting acute rejection in living donor kidney transplantation: a prospective cohort study. Sci Rep 2021; 11:18832. [PMID: 34552150 PMCID: PMC8458304 DOI: 10.1038/s41598-021-98135-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 09/01/2021] [Indexed: 11/16/2022] Open
Abstract
We investigated the clinical relevance of urinary cytokines/chemokines reflecting intrarenal immunologic micromilieu as prognostic markers and the optimal measurement timing after living donor kidney transplantation (LDKT). This prospective cohort study included 77 LDKT patients who were followed for ≥ 5 years. Patients were divided into control (n = 42) or acute rejection (AR, n = 35) group. Early AR was defined as AR occurring within 3 months. Serum and urine cytokines/chemokines were measured serially as follows: intraoperative, 8/24/72 h, 1 week, 3 months, and 1 year after LDKT. Intrarenal total leukocytes, T cells, and B cells were analyzed with immunohistochemistry followed by tissueFAXS. Urinary MCP-1 and fractalkine were also analyzed in a validation cohort. Urinary MCP-1 after one week was higher in the AR group. Urinary MCP-1, fractalkine, TNF-α, RANTES, and IL-6 after one week were significantly higher in the early AR group. Intrarenal total leukocytes and T cells were elevated in the AR group compared with the control group. Urinary fractalkine, MCP-1, and IL-10 showed positive correlation with intrarenal leukocyte infiltration. Post-KT 1 week urinary MCP-1 showed predictive value in the validation cohort. One-week post-KT urinary MCP-1 may be used as a noninvasive diagnostic marker for predicting AR after LDKT.
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Affiliation(s)
- Hye Ryoun Jang
- Division of Nephrology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, Republic of Korea
| | - Minjung Kim
- Division of Nephrology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, Republic of Korea
| | - Sungjun Hong
- Department of Digital Health, Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul, Republic of Korea
| | - Kyungho Lee
- Division of Nephrology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, Republic of Korea
| | - Mee Yeon Park
- Division of Nephrology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, Republic of Korea
| | - Kyeong Eun Yang
- Research Center for Materials Analysis, Korea Basic Science Institute, Daejeon, Republic of Korea
| | - Cheol-Jung Lee
- Research Center for Materials Analysis, Korea Basic Science Institute, Daejeon, Republic of Korea
| | - Junseok Jeon
- Division of Nephrology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, Republic of Korea
| | - Kyo Won Lee
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jung Eun Lee
- Division of Nephrology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, Republic of Korea
| | - Jae Berm Park
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kyunga Kim
- Statistics and Data Center, Samsung Medical Center, Seoul, Republic of Korea
| | - Ghee Young Kwon
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yoon Goo Kim
- Division of Nephrology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, Republic of Korea
| | - Dae Joong Kim
- Division of Nephrology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, Republic of Korea
| | - Wooseong Huh
- Division of Nephrology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, Republic of Korea.
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29
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Protocol Biopsies on de novo Renal-Transplants at 3 Months after Surgery: Impact on 5-Year Transplant Survival. J Clin Med 2021; 10:jcm10163635. [PMID: 34441931 PMCID: PMC8397165 DOI: 10.3390/jcm10163635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 08/14/2021] [Accepted: 08/16/2021] [Indexed: 12/02/2022] Open
Abstract
Background: In many centers, a protocol kidney biopsy (PKB) is performed at 3 months post-transplantation (M3), without a demonstrated benefit on death-censored graft survival (DCGS). In this study, we compared DCGS between kidney transplant recipients undergoing a PKB or without such biopsy while accounting for the obvious indication bias. Methods: In this retrospective, single-center study conducted between 2007 and 2013, we compared DCGS with respect to the availability and features of a PKB. We built a propensity score (PS) to account for PKB indication likelihood and adjusted the DCGS analysis on PKB availability and the PS. Results: A total of 615 patients were included: 333 had a PKB, 282 did not. In bivariate Kaplan–Meier survival analysis, adjusting for the availability of a PKB and for the PS, a PKB was associated with a better 5-year DCGS independently of the PS (p < 0.001). Among the PKB+ patients, 87 recipients (26%) had IF/TA > 0. Patients with an IF/TA score of 3 had the worst survival. A total of 144 patients (44%) showed cv lesions. Patients with cv2 and cv3 lesions had the worst 5-year DCGS. Conclusions: A M3 PKB was associated with improved graft survival independently of potential confounders. These results could be explained by the early treatment of subclinical immunological events. It could be due to better management of the immunosuppressive regimen.
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30
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Luan D, Dadhania DM, Ding R, Muthukumar T, Lubetzky M, Lee JR, Sharma VK, August P, Mueller FB, Schwartz JE, Suthanthiran M. FOXP3 mRNA Profile Prognostic of Acute T Cell-mediated Rejection and Human Kidney Allograft Survival. Transplantation 2021; 105:1825-1839. [PMID: 33031221 PMCID: PMC8024419 DOI: 10.1097/tp.0000000000003478] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND T cell-mediated rejection (TCMR) is the most frequent type of acute rejection and is associated with kidney allograft failure. Almost 40% of TCMR episodes are nonresponsive to therapy, and molecular mechanisms for the nonresponsiveness are unknown. Our single-center study identified that urinary cell FOXP3 mRNA abundance predicts TCMR reversibility and allograft survival. METHODS We developed PCR assays and measured absolute copy numbers of transcripts for FOXP3, CD25, CD3E, perforin, and 18S rRNA in 3559 urines from 480 kidney allograft recipients prospectively enrolled in the multicenter Clinical Trials in Organ Transplantation-04. In this replication study, we investigated the association between mRNA profile and TCMR diagnosis, TCMR reversibility, and allograft survival. RESULTS 18S rRNA normalized levels of mRNA for FOXP3 (P = 0.01, Kruskal-Wallis test), CD25 (P = 0.01), CD3E (P < 0.0001), and perforin (P < 0.0001) were diagnostic of TCMR, but only FOXP3 mRNA level predicted TCMR reversibility (ROC AUC = 0.764; 95% confidence interval, 0.611-0.917; P = 0.008). Multivariable logistic regression analyses showed that urinary cell FOXP3 mRNA level predicted reversal, independent of clinical variables. A composite model of clinical variables and FOXP3 mRNA (AUC = 0.889; 95% CI, 0.781-0.997; P < 0.001) outperformed FOXP3 mRNA or clinical variables in predicting TCMR reversibility (P = 0.01, likelihood ratio test). Multivariable Cox proportional hazards regression analyses showed that FOXP3 mRNA level predicts kidney allograft survival (P = 0.047) but not after controlling for TCMR reversal (P = 0.477). CONCLUSIONS Urinary cell level of FOXP3 mRNA is diagnostic of TCMR, predicts TCMR reversibility, and is prognostic of kidney allograft survival via a mechanism involving TCMR reversal.
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Affiliation(s)
- Danny Luan
- Division of Nephrology and Hypertension, Department of Medicine, New York Presbyterian Hospital-Weill Cornell Medical College, New York, NY, USA
| | - Darshana M. Dadhania
- Division of Nephrology and Hypertension, Department of Medicine, New York Presbyterian Hospital-Weill Cornell Medical College, New York, NY, USA
- Department of Transplantation Medicine, New York Presbyterian Hospital-Weill Cornell Medical College, New York, NY, USA
| | - Ruchuang Ding
- Division of Nephrology and Hypertension, Department of Medicine, New York Presbyterian Hospital-Weill Cornell Medical College, New York, NY, USA
| | - Thangamani Muthukumar
- Division of Nephrology and Hypertension, Department of Medicine, New York Presbyterian Hospital-Weill Cornell Medical College, New York, NY, USA
- Department of Transplantation Medicine, New York Presbyterian Hospital-Weill Cornell Medical College, New York, NY, USA
| | - Michelle Lubetzky
- Division of Nephrology and Hypertension, Department of Medicine, New York Presbyterian Hospital-Weill Cornell Medical College, New York, NY, USA
- Department of Transplantation Medicine, New York Presbyterian Hospital-Weill Cornell Medical College, New York, NY, USA
| | - John R. Lee
- Division of Nephrology and Hypertension, Department of Medicine, New York Presbyterian Hospital-Weill Cornell Medical College, New York, NY, USA
- Department of Transplantation Medicine, New York Presbyterian Hospital-Weill Cornell Medical College, New York, NY, USA
| | - Vijay K. Sharma
- Division of Nephrology and Hypertension, Department of Medicine, New York Presbyterian Hospital-Weill Cornell Medical College, New York, NY, USA
| | - Phyllis August
- Division of Nephrology and Hypertension, Department of Medicine, New York Presbyterian Hospital-Weill Cornell Medical College, New York, NY, USA
- Department of Transplantation Medicine, New York Presbyterian Hospital-Weill Cornell Medical College, New York, NY, USA
| | - Franco B. Mueller
- Division of Nephrology and Hypertension, Department of Medicine, New York Presbyterian Hospital-Weill Cornell Medical College, New York, NY, USA
| | - Joseph E. Schwartz
- Division of Nephrology and Hypertension, Department of Medicine, New York Presbyterian Hospital-Weill Cornell Medical College, New York, NY, USA
- Department of Psychiatry and Behavioral Health, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Manikkam Suthanthiran
- Division of Nephrology and Hypertension, Department of Medicine, New York Presbyterian Hospital-Weill Cornell Medical College, New York, NY, USA
- Department of Transplantation Medicine, New York Presbyterian Hospital-Weill Cornell Medical College, New York, NY, USA
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Paul RS, Almokayad I, Collins A, Raj D, Jagadeesan M. Donor-derived Cell-free DNA: Advancing a Novel Assay to New Heights in Renal Transplantation. Transplant Direct 2021; 7:e664. [PMID: 33564715 PMCID: PMC7862009 DOI: 10.1097/txd.0000000000001098] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 10/09/2020] [Accepted: 10/13/2020] [Indexed: 02/07/2023] Open
Abstract
Despite advances in transplant immunosuppression, long-term renal allograft outcomes remain suboptimal because of the occurrence of rejection, recurrent disease, and interstitial fibrosis with tubular atrophy. This is largely due to limitations in our understanding of allogeneic processes coupled with inadequate surveillance strategies. The concept of donor-derived cell-free DNA as a signal of allograft stress has therefore rapidly been adopted as a noninvasive monitoring tool. Refining it for effective clinical use, however, remains an ongoing effort. Furthermore, its potential to unravel new insights in alloimmunity through novel molecular techniques is yet to be realized. This review herein summarizes current knowledge and active endeavors to optimize cell-free DNA-based diagnostic techniques for clinical use in kidney transplantation. In addition, the integration of DNA methylation and microRNA may unveil new epigenetic signatures of allograft health and is also explored in this report. Directing research initiatives toward these aspirations will not only improve diagnostic precision but may foster new paradigms in transplant immunobiology.
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Affiliation(s)
- Rohan S. Paul
- Division of Kidney Disease & Hypertension, George Washington University, Washington, DC
| | - Ismail Almokayad
- Division of Kidney Disease & Hypertension, George Washington University, Washington, DC
| | - Ashte Collins
- Division of Kidney Disease & Hypertension, George Washington University, Washington, DC
| | - Dominic Raj
- Division of Kidney Disease & Hypertension, George Washington University, Washington, DC
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Como G, Da Re J, Adani GL, Zuiani C, Girometti R. Role for contrast-enhanced ultrasound in assessing complications after kidney transplant. World J Radiol 2020; 12:156-171. [PMID: 32913562 PMCID: PMC7457161 DOI: 10.4329/wjr.v12.i8.156] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 04/30/2020] [Accepted: 07/18/2020] [Indexed: 02/06/2023] Open
Abstract
Kidney transplantation (KT) is an effective treatment for end-stage renal disease. Despite their rate has reduced over time, post-transplant complications still represent a major clinical problem because of the associated risk of graft failure and loss. Thus, post-KT complications should be diagnosed and treated promptly. Imaging plays a pivotal role in this setting. Grayscale ultrasound (US) with color Doppler analysis is the first-line imaging modality for assessing complications, although many findings lack specificity. When performed by experienced operators, contrast-enhanced US (CEUS) has been advocated as a safe and fast tool to improve the accuracy of US. Also, when performing CEUS there is potentially no need for further imaging, such as contrast-enhanced computed tomography or magnetic resonance imaging, which are often contraindicated in recipients with impaired renal function. This technique is also portable to patients' bedside, thus having the potential of maximizing the cost-effectiveness of the whole diagnostic process. Finally, the use of blood-pool contrast agents allows translating information on graft microvasculature into time-intensity curves, and in turn quantitative perfusion indexes. Quantitative analysis is under evaluation as a tool to diagnose rejection or other causes of graft dysfunction. In this paper, we review and illustrate the indications to CEUS in the post-KT setting, as well as the main CEUS findings that can help establishing the diagnosis and planning the most adequate treatment.
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Affiliation(s)
- Giuseppe Como
- Institute of Radiology, University Hospital S. Maria della Misericordia, Udine 33100, Italy
| | - Jacopo Da Re
- Institute of Radiology, Department of Medicine, University of Udine, University Hospital S. Maria della Misericordia, Udine 33100, Italy
| | - Gian Luigi Adani
- Department of Medicine, General Surgery and Transplantation, University Hospital S. Maria della Misericordia, Udine 33100, Italy
| | - Chiara Zuiani
- Institute of Radiology, Department of Medicine, University of Udine, University Hospital S. Maria della Misericordia, Udine 33100, Italy
| | - Rossano Girometti
- Institute of Radiology, Department of Medicine, University of Udine, University Hospital S. Maria della Misericordia, Udine 33100, Italy
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Wilson MP, Katlariwala P, Low G. More Studies are Needed Evaluating the Diagnostic Accuracy of Magnetic Resonance Elastography for Allograft Renal Transplant Rejection. Korean J Radiol 2020; 21:1024-1025. [PMID: 32677387 PMCID: PMC7369209 DOI: 10.3348/kjr.2020.0242] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Revised: 03/07/2020] [Accepted: 03/07/2020] [Indexed: 01/19/2023] Open
Affiliation(s)
- Mitchell P Wilson
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Canada.
| | - Prayash Katlariwala
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Canada
| | - Gavin Low
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Canada
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Magnetic Resonance Imaging for Evaluation of Interstitial Fibrosis in Kidney Allografts. Transplant Direct 2020; 6:e577. [PMID: 33134501 PMCID: PMC7581173 DOI: 10.1097/txd.0000000000001009] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 04/28/2020] [Indexed: 12/16/2022] Open
Abstract
Supplemental Digital Content is available in the text. Interstitial fibrosis (IF) is the common pathway of chronic kidney injury in various conditions. Magnetic resonance imaging (MRI) may be a promising tool for the noninvasive assessment of IF in renal allografts.
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Sugi MD, Joshi G, Maddu KK, Dahiya N, Menias CO. Imaging of Renal Transplant Complications throughout the Life of the Allograft: Comprehensive Multimodality Review. Radiographics 2020; 39:1327-1355. [PMID: 31498742 DOI: 10.1148/rg.2019190096] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The kidney is the most commonly transplanted solid organ. Advances in surgical techniques, immunosuppression regimens, surveillance imaging, and histopathologic diagnosis of rejection have allowed prolonged graft survival times. However, the demand for kidneys continues to outgrow the available supply, and there are efforts to increase use of donor kidneys with moderate- or high-risk profiles. This highlights the importance of evaluating the renal transplant patient in the context of both donor and recipient risk factors. Radiologists play an integral role within the multidisciplinary team in care of the transplant patient at every stage of the transplant process. In the immediate postoperative period, duplex US is the modality of choice for evaluating the renal allograft. It is useful for establishing a baseline examination for comparison at future surveillance imaging. In the setting of allograft dysfunction, advanced imaging techniques including MRI or contrast-enhanced US may be useful for providing a more specific diagnosis and excluding nonrejection causes of renal dysfunction. When a pathologic diagnosis is deemed necessary to guide therapy, US-guided biopsy is a relatively low-risk, safe procedure. The range of complications of renal transplantation can be organized temporally in relation to the time since surgery and/or according to disease categories, including immunologic (rejection), surgical or iatrogenic, vascular, urinary, infectious, and neoplastic complications. The unique heterotopic location of the renal allograft in the iliac fossa predisposes it to a specific set of complications. As imaging features of infection or malignancy may be nonspecific, awareness of the patient's risk profile and time since transplantation can be used to assign the probability of a certain diagnosis and thus guide more specific diagnostic workup. It is critical to understand variations in vascular anatomy, surgical technique, and independent donor and recipient risk factors to make an accurate diagnosis and initiate appropriate treatment.©RSNA, 2019.
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Affiliation(s)
- Mark D Sugi
- From the Department of Radiology, Mayo Clinic, Scottsdale, Ariz (M.D.S., N.D., C.O.M.); and Departments of Radiology and Imaging Sciences (G.J., K.K.M.) and Emergency Medicine (G.J., K.K.M.), Emory University School of Medicine, Atlanta, Ga
| | - Gayatri Joshi
- From the Department of Radiology, Mayo Clinic, Scottsdale, Ariz (M.D.S., N.D., C.O.M.); and Departments of Radiology and Imaging Sciences (G.J., K.K.M.) and Emergency Medicine (G.J., K.K.M.), Emory University School of Medicine, Atlanta, Ga
| | - Kiran K Maddu
- From the Department of Radiology, Mayo Clinic, Scottsdale, Ariz (M.D.S., N.D., C.O.M.); and Departments of Radiology and Imaging Sciences (G.J., K.K.M.) and Emergency Medicine (G.J., K.K.M.), Emory University School of Medicine, Atlanta, Ga
| | - Nirvikar Dahiya
- From the Department of Radiology, Mayo Clinic, Scottsdale, Ariz (M.D.S., N.D., C.O.M.); and Departments of Radiology and Imaging Sciences (G.J., K.K.M.) and Emergency Medicine (G.J., K.K.M.), Emory University School of Medicine, Atlanta, Ga
| | - Christine O Menias
- From the Department of Radiology, Mayo Clinic, Scottsdale, Ariz (M.D.S., N.D., C.O.M.); and Departments of Radiology and Imaging Sciences (G.J., K.K.M.) and Emergency Medicine (G.J., K.K.M.), Emory University School of Medicine, Atlanta, Ga
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Zafar ZS, P Marin E. Hypertension and Acute Kidney Injury following an Allograft Biopsy. KIDNEY360 2020; 1:152-153. [PMID: 35372911 PMCID: PMC8809104 DOI: 10.34067/kid.0000252019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- Zubair Saeed Zafar
- Section of Nephrology, Department of Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Ethan P Marin
- Section of Nephrology, Department of Medicine, Yale School of Medicine, New Haven, Connecticut
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Abuelo JG. How long should patients be observed after percutaneous kidney biopsies? Nephrol Dial Transplant 2019; 34:1979-1981. [PMID: 31377770 DOI: 10.1093/ndt/gfz157] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Indexed: 11/13/2022] Open
Affiliation(s)
- Julian Gary Abuelo
- Department of Medicine, Division of Hypertension and Kidney Diseases, Rhode Island Hospital, Alpert Medical School of Brown University, Providence, RI, USA
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Anglicheau D, Tinel C, Canaud G, Loupy A, Zuber J, Delville M, Rabaté C, Scemla A, Snanoudj R, Sberro-Soussan R, Mamzer-Bruneel MF, Bererhi L, Martinez F, Timsit MO, Rabant M, Correas JM, Bienaimé F, Duong JP, Hélénon O, Prié D, Méjean A, Legendre C. [Renal transplantation: Procedure and early follow-up]. Nephrol Ther 2019; 15:469-484. [PMID: 31640943 DOI: 10.1016/j.nephro.2019.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
More than fifty years after the success of the two first renal transplantations in Boston and in Necker hospital in Paris, renal transplantation became the treatment of choice of end stage renal failure, because it improves not only the quality of life of the patients but also their long-term survival. In France, more than 3,700 kidney transplantations are performed every year and more than 40,000 patients are living with a functioning kidney allograft. This treatment of end stage renal disease requires a fine-tuned pre-transplant evaluation and a multidisciplinary post-transplant care in order to prevent, to detect and to treat comorbidities and complications of immunosuppression. The ambition of this manuscript is not to describe in an exhaustive way all the aspects of renal transplantation but starting from the experience of a team, recently published data, and national and international guidelines, to try to provide a synthetic and chronological view of the early post-transplant monitoring.
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Affiliation(s)
- Dany Anglicheau
- Faculté de médecine, université Paris-Descartes, Université de Paris, 75006 Paris, France; Service de néphrologie et transplantation adulte, hôpital Necker, AP-HP, 149, rue de Sèvres, 75015 Paris, France.
| | - Claire Tinel
- Faculté de médecine, université Paris-Descartes, Université de Paris, 75006 Paris, France; Service de néphrologie et transplantation adulte, hôpital Necker, AP-HP, 149, rue de Sèvres, 75015 Paris, France
| | - Guillaume Canaud
- Faculté de médecine, université Paris-Descartes, Université de Paris, 75006 Paris, France; Service de néphrologie et transplantation adulte, hôpital Necker, AP-HP, 149, rue de Sèvres, 75015 Paris, France
| | - Alexandre Loupy
- Faculté de médecine, université Paris-Descartes, Université de Paris, 75006 Paris, France; Service de néphrologie et transplantation adulte, hôpital Necker, AP-HP, 149, rue de Sèvres, 75015 Paris, France
| | - Julien Zuber
- Faculté de médecine, université Paris-Descartes, Université de Paris, 75006 Paris, France; Service de néphrologie et transplantation adulte, hôpital Necker, AP-HP, 149, rue de Sèvres, 75015 Paris, France
| | - Marianne Delville
- Faculté de médecine, université Paris-Descartes, Université de Paris, 75006 Paris, France; Service de néphrologie et transplantation adulte, hôpital Necker, AP-HP, 149, rue de Sèvres, 75015 Paris, France
| | - Clémentine Rabaté
- Faculté de médecine, université Paris-Descartes, Université de Paris, 75006 Paris, France; Service de néphrologie et transplantation adulte, hôpital Necker, AP-HP, 149, rue de Sèvres, 75015 Paris, France
| | - Anne Scemla
- Faculté de médecine, université Paris-Descartes, Université de Paris, 75006 Paris, France
| | - Renaud Snanoudj
- Faculté de médecine, université Paris-Descartes, Université de Paris, 75006 Paris, France
| | - Rébecca Sberro-Soussan
- Faculté de médecine, université Paris-Descartes, Université de Paris, 75006 Paris, France
| | | | - Lynda Bererhi
- Faculté de médecine, université Paris-Descartes, Université de Paris, 75006 Paris, France
| | - Frank Martinez
- Faculté de médecine, université Paris-Descartes, Université de Paris, 75006 Paris, France
| | - Marc-Olivier Timsit
- Faculté de médecine, université Paris-Descartes, Université de Paris, 75006 Paris, France; Service d'urologie, hôpital européen Georges-Pompidou, AP-HP, 20, rue Leblanc, 75015 Paris, France
| | - Marion Rabant
- Faculté de médecine, université Paris-Descartes, Université de Paris, 75006 Paris, France; Service d'anatomie pathologique, hôpital Necker, AP-HP, 149, rue de Sèvres, 75015 Paris, France
| | - Jean-Michel Correas
- Faculté de médecine, université Paris-Descartes, Université de Paris, 75006 Paris, France; Service de radiologie adulte, hôpital Necker, AP-HP, 149, rue de Sèvres, 75015 Paris, France
| | - Frank Bienaimé
- Faculté de médecine, université Paris-Descartes, Université de Paris, 75006 Paris, France; Service d'exploration fonctionnelle, hôpital Necker, AP-HP, 149, rue de Sèvres, 75015 Paris, France
| | - Jean-Paul Duong
- Faculté de médecine, université Paris-Descartes, Université de Paris, 75006 Paris, France; Service d'anatomie pathologique, hôpital Necker, AP-HP, 149, rue de Sèvres, 75015 Paris, France
| | - Olivier Hélénon
- Faculté de médecine, université Paris-Descartes, Université de Paris, 75006 Paris, France; Service de radiologie adulte, hôpital Necker, AP-HP, 149, rue de Sèvres, 75015 Paris, France
| | - Dominique Prié
- Faculté de médecine, université Paris-Descartes, Université de Paris, 75006 Paris, France; Service d'exploration fonctionnelle, hôpital Necker, AP-HP, 149, rue de Sèvres, 75015 Paris, France
| | - Arnaud Méjean
- Faculté de médecine, université Paris-Descartes, Université de Paris, 75006 Paris, France; Service d'urologie, hôpital européen Georges-Pompidou, AP-HP, 20, rue Leblanc, 75015 Paris, France
| | - Christophe Legendre
- Faculté de médecine, université Paris-Descartes, Université de Paris, 75006 Paris, France; Service de néphrologie et transplantation adulte, hôpital Necker, AP-HP, 149, rue de Sèvres, 75015 Paris, France
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Fang J, Li G, Xu L, Zhang L, Yin W, Lai X, Guo Y, Chen R, Li L, Xiong Y, Liu L, Zhang T, Wan J, Zhang P, Xu H, Wu J, Pan G, Ma J, Chen Z. Complications and clinical management of ultrasound-guided renal allograft biopsies. Transl Androl Urol 2019; 8:292-296. [PMID: 31555552 DOI: 10.21037/tau.2019.07.23] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background In this paper, the regular flow of ultrasound-guided renal allograft biopsies was established by analyzing complications and clinical management principle of ultrasound-guided renal allograft biopsies, to increase the safety of ultrasound-guided renal allograft biopsies. Methods The purpose of this study was to analyze the cases of ultrasound-guided renal allograft biopsies in our hospital from January 2006 to October 2018 because of abnormal renal function (including symptoms of albuminuria and elevated serum creatinine). The type of puncture needle used in renal allograft biopsies, the number of puncture needle and the relationship between puncture needle and complication were counted, and the treatment measures were analyzed. Results From January 2006 to October 2018, a total of 487 patients underwent ultrasound-guided renal allograft biopsies in our hospital. Among them, the successful sampling rate was 98.8%, and the average number of glomeruli per specimen was 15.24±2.26. The complications of the patient after puncture included: perirenal hematomas, subcapsular hematomas, acute ureter obstruction caused by hematuria, gross hematuria, and microscopic hematuria. Among them, two patients were treated with open surgery to save the function of renal transplantation, and the primary treatment measures were to increase the absolute bed rest time. The symptoms of the patients were relieved after treatment. Conclusions The analysis showed that ultrasound-guided renal allograft biopsies are safe and feasible, and the analysis of the biopsies of patients can provide meaningful pathological information for the clinic.
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Affiliation(s)
- Jiali Fang
- Organ Transplant Center, Second Affiliated Hospital of Guangzhou Medical University, Guangzhou 511447, China
| | - Guanghui Li
- Organ Transplant Center, Second Affiliated Hospital of Guangzhou Medical University, Guangzhou 511447, China
| | - Lu Xu
- Organ Transplant Center, Second Affiliated Hospital of Guangzhou Medical University, Guangzhou 511447, China
| | - Lei Zhang
- Organ Transplant Center, Second Affiliated Hospital of Guangzhou Medical University, Guangzhou 511447, China
| | - Wei Yin
- Organ Transplant Center, Second Affiliated Hospital of Guangzhou Medical University, Guangzhou 511447, China
| | - Xingqiang Lai
- Organ Transplant Center, Second Affiliated Hospital of Guangzhou Medical University, Guangzhou 511447, China
| | - Yuhe Guo
- Organ Transplant Center, Second Affiliated Hospital of Guangzhou Medical University, Guangzhou 511447, China
| | - Rongxin Chen
- Organ Transplant Center, Second Affiliated Hospital of Guangzhou Medical University, Guangzhou 511447, China
| | - Li Li
- Organ Transplant Center, Second Affiliated Hospital of Guangzhou Medical University, Guangzhou 511447, China
| | - Yunyi Xiong
- Organ Transplant Center, Second Affiliated Hospital of Guangzhou Medical University, Guangzhou 511447, China
| | - Luhao Liu
- Organ Transplant Center, Second Affiliated Hospital of Guangzhou Medical University, Guangzhou 511447, China
| | - Tao Zhang
- Organ Transplant Center, Second Affiliated Hospital of Guangzhou Medical University, Guangzhou 511447, China
| | - Jiao Wan
- Organ Transplant Center, Second Affiliated Hospital of Guangzhou Medical University, Guangzhou 511447, China
| | - Peng Zhang
- Organ Transplant Center, Second Affiliated Hospital of Guangzhou Medical University, Guangzhou 511447, China
| | - Hailin Xu
- Organ Transplant Center, Second Affiliated Hospital of Guangzhou Medical University, Guangzhou 511447, China
| | - Jialin Wu
- Organ Transplant Center, Second Affiliated Hospital of Guangzhou Medical University, Guangzhou 511447, China
| | - Guanghui Pan
- Organ Transplant Center, Second Affiliated Hospital of Guangzhou Medical University, Guangzhou 511447, China
| | - Junjie Ma
- Organ Transplant Center, Second Affiliated Hospital of Guangzhou Medical University, Guangzhou 511447, China
| | - Zheng Chen
- Organ Transplant Center, Second Affiliated Hospital of Guangzhou Medical University, Guangzhou 511447, China
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Cortesi C, Sedki M, Ruiz P, Salsamendi J, Mattiazzi A. Computed Tomography-Guided Kidney Transplant Biopsy Outcomes: A Single-Center Experience. EXP CLIN TRANSPLANT 2019; 18:676-681. [PMID: 31526335 DOI: 10.6002/ect.2019.0111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Percutaneous kidney transplant biopsy is typically performed using ultrasonographic guidance; computed tomography is an alternative modality used to obtain kidney allografttissuewhen ultrasonographyguided percutaneous kidney transplant biopsy is technically challenging. Studies examining postbiopsy outcomes in kidney transplant patients using a computed tomography-guided approach are scarce. Our goal was to reportthe incidence of nonsevere and severe complications in computed tomographyguided percutaneous kidney transplant biopsies and the potential risk factors. MATERIALS AND METHODS We retrospectively reviewed computed tomography-guided percutaneous kidney transplant biopsies in patients undergoing work-up for kidney allograft rejection between 2013 and 2017. Demographics, comorbidities, laboratory data, history of antiplatelet and/or anticoagulant use, and complications were assessed. RESULTS : During the study period, 28 patients underwent computed tomography-guided percutaneous kidney transplant biopsies; mean age was 57.5 ± 15.5 years, and 12 (43%)werewomen.Twenty-three patients (82%) were obese, with a body mass index greater than 30 kg/m². Our cohort of kidney transplant recipients included 21 (75%) from deceased donors and 7 (25%) from living-related donors. At the time of biopsy, 6 patients (21%) had elevated blood pressure (defined as > 160/90 mm Hg). One patient had severe complications, which included a significant decrease in hemoglobin requiring transfusion and a perinephric hematoma with worsening renal function. This was a morbidly obese patient whose blood pressure was elevated at the time of biopsy with a platelet count of 93 × 10³/mm³ and international normalized ratio of 1.21. CONCLUSIONS A computed tomography-guided percutaneous kidney transplant biopsy is a safe and effective alternative to obtain kidney tissue in the obese population and is associated with low rates of complications. In this study, we highlighted the need to achieve adequate blood pressure control and assess bleeding risk factors, such as platelet count and international normalized ratio, prior to biopsy.
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Affiliation(s)
- Camilo Cortesi
- From the Division of Nephrology, Department of Medicine, University of California San Francisco, San Francisco, California, USA
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Zhang W, Yi Z, Keung KL, Shang H, Wei C, Cravedi P, Sun Z, Xi C, Woytovich C, Farouk S, Huang W, Banu K, Gallon L, Magee CN, Najafian N, Samaniego M, Djamali A, Alexander SI, Rosales IA, Smith RN, Xiang J, Lerut E, Kuypers D, Naesens M, O'Connell PJ, Colvin R, Menon MC, Murphy B. A Peripheral Blood Gene Expression Signature to Diagnose Subclinical Acute Rejection. J Am Soc Nephrol 2019; 30:1481-1494. [PMID: 31278196 DOI: 10.1681/asn.2018111098] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 05/01/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND In kidney transplant recipients, surveillance biopsies can reveal, despite stable graft function, histologic features of acute rejection and borderline changes that are associated with undesirable graft outcomes. Noninvasive biomarkers of subclinical acute rejection are needed to avoid the risks and costs associated with repeated biopsies. METHODS We examined subclinical histologic and functional changes in kidney transplant recipients from the prospective Genomics of Chronic Allograft Rejection (GoCAR) study who underwent surveillance biopsies over 2 years, identifying those with subclinical or borderline acute cellular rejection (ACR) at 3 months (ACR-3) post-transplant. We performed RNA sequencing on whole blood collected from 88 individuals at the time of 3-month surveillance biopsy to identify transcripts associated with ACR-3, developed a novel sequencing-based targeted expression assay, and validated this gene signature in an independent cohort. RESULTS Study participants with ACR-3 had significantly higher risk than those without ACR-3 of subsequent clinical acute rejection at 12 and 24 months, faster decline in graft function, and decreased graft survival in adjusted Cox analysis. We identified a 17-gene signature in peripheral blood that accurately diagnosed ACR-3, and validated it using microarray expression profiles of blood samples from 65 transplant recipients in the GoCAR cohort and three public microarray datasets. In an independent cohort of 110 transplant recipients, tests of the targeted expression assay on the basis of the 17-gene set showed that it identified individuals at higher risk of ongoing acute rejection and future graft loss. CONCLUSIONS Our targeted expression assay enabled noninvasive diagnosis of subclinical acute rejection and inflammation in the graft and may represent a useful tool to risk-stratify kidney transplant recipients.
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Affiliation(s)
- Weijia Zhang
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Zhengzi Yi
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Karen L Keung
- Department of Medicine, Westmead Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Huimin Shang
- Department of Microbiology and Immunology, Cornell Medical Center, New York, New York
| | - Chengguo Wei
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Paolo Cravedi
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Zeguo Sun
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Caixia Xi
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Christopher Woytovich
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Samira Farouk
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Weiqing Huang
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Khadija Banu
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Lorenzo Gallon
- Department of Medicine-Nephrology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Ciara N Magee
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Nader Najafian
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Milagros Samaniego
- Division of Nephrology, Department of Medicine, Henry Ford Hospital, Detroit, Michigan
| | - Arjang Djamali
- Division of Nephrology, Department of Medicine, University of Wisconsin, Madison, Wisconsin
| | - Stephen I Alexander
- Department of Medicine, Westmead Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Ivy A Rosales
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Rex Neal Smith
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jenny Xiang
- Department of Microbiology and Immunology, Cornell Medical Center, New York, New York
| | | | - Dirk Kuypers
- Department of Microbiology and Immunology, Katholieke Universiteit Leuven, Leuven, Belgium.,Nephrology and Renal Transplantation, University Hospitals Leuven, Leuven, Belgium; and
| | - Maarten Naesens
- Department of Microbiology and Immunology, Katholieke Universiteit Leuven, Leuven, Belgium.,Nephrology and Renal Transplantation, University Hospitals Leuven, Leuven, Belgium; and
| | - Philip J O'Connell
- Department of Medicine, Westmead Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Robert Colvin
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Madhav C Menon
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Barbara Murphy
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York;
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Wu CY, Yu TM, Wu MJ, Chuang YW. Prognostic Value of Effective Renal Plasma Flow for First-year Renal Outcome in Kidney Allograft Recipients. Transplant Proc 2019; 51:1353-1356. [PMID: 31056247 DOI: 10.1016/j.transproceed.2019.02.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Revised: 01/26/2019] [Accepted: 02/03/2019] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Many studies have suggested that post-transplantation renal allograft function is associated with long-term allograft outcomes. However, accurate examination through non-invasive methods remains rare. The aim of the present study is to assess the association between 99mTc mercaptoacetyltriglycine (MAG3) effective renal plasma flow (ERPF) and first-year post-transplantation renal allograft function. METHODS We conducted a retrospective cohort study at our center between January 2011 and December 2016. Kidney transplant recipients without an ERPF examination within 14 days post-transplantation, or those with less than 1 year of follow-up were excluded. Eligible cases were divided into 3 groups according to first-year eGFR <45, 45 < eGFR <60, eGFR >60. The Kruskal-Wallis test and χ2 were used for comparisons between continuous and categorical variables. RESULTS A total of 123 patients were analyzed. Each group received 41 patients. The baseline characteristics were comparable in the 3 groups, except for repeated transplantation and delayed graft function. The results of the ERPF median (interquartile range) for the 3 groups were 193 (140.0-244.5) in the eGFR < 45 group, 236 (182.5-301.0) in the 45 < eGFR < 60 group, and 294 (202.5-384.5) in the eGFR > 60 group (P < .001). The receiver operating characteristic analysis showed that a cutoff ERPF value of >276 exhibited the best sensitivity (65.85%) and specificity (75.61%) for predicting first-year eGFR > 60 mL/min/1.73 m2, with an area under the receiver operating characteristic curve of .712, P < .0001. CONCLUSION Our findings suggest that an ERPF value of more than 276 is likely to be associated with a favorable first-year renal graft outcome after transplantation. The 99mTc MAG3 ERPF may be a non-invasive alternative to sequential protocol biopsies.
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Affiliation(s)
- Chun-Yi Wu
- Division of Nephrology, Taichung Veterans General Hospital, Taichung City, Taiwan
| | - Tung-Min Yu
- Division of Nephrology, Taichung Veterans General Hospital, Taichung City, Taiwan
| | - Ming-Ju Wu
- Division of Nephrology, Taichung Veterans General Hospital, Taichung City, Taiwan
| | - Ya-Wen Chuang
- Division of Nephrology, Taichung Veterans General Hospital, Taichung City, Taiwan.
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Clinical Significance of Renal Allograft Protocol Biopsies: A Single Tertiary Center Experience in Malaysia. J Transplant 2019; 2019:9153875. [PMID: 31186948 PMCID: PMC6521333 DOI: 10.1155/2019/9153875] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Revised: 02/15/2019] [Accepted: 03/17/2019] [Indexed: 11/18/2022] Open
Abstract
Background The role of protocol renal allograft biopsy in kidney transplantation is controversial due to the concern with procedural-related complications; however, its role is slowly evolving. Recent evidence suggests that protocol biopsy is useful in detecting subclinical renal pathology. Early recognition and treatment of renal pathologies can improve long-term outcomes of renal allografts. Methodology A total of 362 renal allograft protocol biopsies were performed in adult recipients of kidney transplantation between 2012 and 2017. After excluding those with poor quality or those performed with a baseline serum creatinine level >200 umol/L, we analyzed 334 (92.3%) biopsies. Histology reports were reviewed and categorized into histoimmunological and nonimmunological changes. The immunological changes were subcategorized into the following: (1) no acute rejection (NR), (2) borderline changes (BC), and (3) subclinical rejection (SCR). Nonimmunological changes were subcategorized into the following: (1) chronicity including interstitial fibrosis/tubular atrophy (IFTA), chronic T-cell-mediated rejection (TCMR), unspecified chronic lesions, and arterionephrosclerosis, (2) de novo glomerulopathy/recurrence of primary disease (RP), and (3) other clinically unsuspected lesions (acute pyelonephritis, calcineurin inhibitors toxicity, postinfective glomerulonephritis, and BK virus nephropathy). Risk factors associated with SCR were assessed. Results For the histoimmunological changes, 161 (48.2%) showed NR, 145 (43.4%) were BC, and 28 (8.4%) were SCR. These clinical events were more pronounced for the first 5 years; our data showed BC accounted for 59 (36.4%), 64 (54.2%), and 22 (40.7%) biopsies within <1 year, 1-5 years, and > 5 years, respectively (p = 0.011). Meanwhile, the incidence for SCR was 6 (3.7%) biopsies in <1 year, 18 (15.3%) in 1-5 years, and 4 (7.4%) in >5 years after transplantation (p=0.003). For the nonimmunological changes, chronicity, de novo glomerulopathy/RP, and other clinically unsuspected lesions were seen in 40 (12%), 10 (3%), and 12 (3.6%) biopsies, respectively. Living-related donor recipients were associated with decreased SCR (p=0.007). Conclusions Despite having a stable renal function, our transplant recipients had a significant number of subclinical rejection on renal allograft biopsies.
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Gordillo R, Munshi R, Monroe EJ, Shivaram GM, Smith JM. Benefits and risks of protocol biopsies in pediatric renal transplantation. Pediatr Nephrol 2019; 34:593-598. [PMID: 29725772 DOI: 10.1007/s00467-018-3959-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 03/14/2018] [Accepted: 04/03/2018] [Indexed: 11/30/2022]
Abstract
Protocol biopsies are defined as sampling of allograft tissue at predetermined times regardless of function. This procedure can be justified due to the lack of non-invasive methods to reliably diagnose rejection (acute or subclinical). Changes in creatinine are not seen with subclinical rejection or early acute rejection and do not always correlate with efficacy of treatment. Parents and providers are still hesitant to pursue protocol biopsy due to the potential complications and lack of definitive evidence of a benefit from doing this procedure. Importantly, the rate of transplant renal biopsy complications requiring additional intervention is low. It is unclear if detection and treatment of subclinical rejection detected on protocol biopsy will lead to improved graft survival. Our goal is to review the literature on this topic and share some of the experience in our center. Definition, indications, and complications of diagnostic transplant renal biopsies are not included in this review.
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Affiliation(s)
- Roberto Gordillo
- Division of Nephrology, Seattle Children's Hospital, University of Washington, Seattle, WA, USA.
| | - Raj Munshi
- Division of Nephrology, Seattle Children's Hospital, University of Washington, Seattle, WA, USA
| | - Eric J Monroe
- Division of Radiology, Seattle Children's Hospital, University of Washington, Seattle, WA, USA
| | - Giridhar M Shivaram
- Division of Radiology, Seattle Children's Hospital, University of Washington, Seattle, WA, USA
| | - Jodi M Smith
- Division of Nephrology, Seattle Children's Hospital, University of Washington, Seattle, WA, USA
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Trajceska L, Severova-Andreevska G, Dzekova-Vidimliski P, Nikolov I, Selim G, Spasovski G, Rambabova-Busletik I, Ristovska V, Grcevska L, Sikole A. Complications and Risks of Percutaneous Renal Biopsy. Open Access Maced J Med Sci 2019; 7:992-995. [PMID: 30976347 PMCID: PMC6454172 DOI: 10.3889/oamjms.2019.226] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 03/18/2019] [Accepted: 03/19/2019] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Renal biopsy performed in native and transplant kidneys is generally considered a safe procedure. AIM In this study, we evaluated renal biopsy complications and risk factors in one nephrology facility. MATERIAL AND METHODS We conducted a three-year retrospective study on patients who underwent renal biopsy between January 2014 and December 2016. Strict written biopsy protocol was followed. Clinical and laboratory data were obtained from medical charts. Complications were categorised as minor and major, according to the need for intervention. Minor complications included macrohematuria and/or hematoma that did not require intervention. Major complications included hematuria or hematoma with fall of hematocrit that required a blood transfusion, surgery or caused death. A binary logistic regression model was used to analyse the possible factors associated with complications after the biopsy. RESULTS We analysed 345 biopsies; samples were taken from patients aged from 15-81 years, of whom 61% were men. A total of 21 (6%) patients developed a complication, 4.4% minor and 1.7% major complications. There were no nephrectomy or death due to biopsy intervention. Overweight patients, as well as those with higher creatinine, lower hemoglobin, higher blood pressure and biopsy due to AKI had higher chances to develop complications (p = 0.037, p = 0.023, p = 0.032, p = 0.002, p = 0.002, respectively). The patients' age, gender, kidney dimension, number of passes and uninterrupted aspirin therapy were not found as significant predictors of complications. In the multivariate logistic model, body weight (OR = 1.031, 95%CI = 1.002-1.062), lower hemoglobin (OR = 0.973, 95%CI = 0.951-0.996) and hypertension (OR = 1.025, 95%CI = 1.007-1.044) increased the risk of complications in biopsied patients. CONCLUSION Renal biopsy is a safe procedure with a low risk of complications when strict biopsy protocol is observed. Correction of anaemia and blood pressure is to be considered before the biopsy.
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Affiliation(s)
- Lada Trajceska
- University Clinic of Nephrology, Faculty of Medicine, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
| | - Galina Severova-Andreevska
- University Clinic of Nephrology, Faculty of Medicine, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
| | - Pavlina Dzekova-Vidimliski
- University Clinic of Nephrology, Faculty of Medicine, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
| | - Igor Nikolov
- University Clinic of Nephrology, Faculty of Medicine, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
| | - Gjulsen Selim
- University Clinic of Nephrology, Faculty of Medicine, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
| | - Goce Spasovski
- University Clinic of Nephrology, Faculty of Medicine, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
| | - Irena Rambabova-Busletik
- University Clinic of Nephrology, Faculty of Medicine, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
| | - Vesna Ristovska
- University Clinic of Nephrology, Faculty of Medicine, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
| | - Ladislava Grcevska
- University Clinic of Nephrology, Faculty of Medicine, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
| | - Aleksandar Sikole
- University Clinic of Nephrology, Faculty of Medicine, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
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Hectors SJ, Bane O, Kennedy P, El Salem F, Menon M, Segall M, Khaim R, Delaney V, Lewis S, Taouli B. T 1ρ mapping for assessment of renal allograft fibrosis. J Magn Reson Imaging 2019; 50:1085-1091. [PMID: 30666744 DOI: 10.1002/jmri.26656] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Revised: 01/02/2019] [Accepted: 01/03/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND There is an unmet need for noninvasive methods to diagnose and stage renal allograft fibrosis. PURPOSE To investigate the utility of T1ρ measured with MRI for the assessment of fibrosis in renal allografts. STUDY TYPE Institutional Review Board (IRB)-approved prospective. SUBJECTS Fifteen patients with stable functional allograft (M/F 9/6, mean age 56 years) and 12 patients with allograft dysfunction and established fibrosis (M/F 6/6, mean age 51 years). FIELD STRENGTH/SEQUENCE T1ρ imaging at 1.5T using a custom-developed sequence. ASSESSMENT Average T1ρ in the cortex and medulla was quantified and T1ρ repeatability (expressed by the coefficient of variation [CV]) was measured in four patients. STATISTICAL TESTS Differences in T1ρ values between the 2 groups were assessed using Mann-Whitney U-tests. Diagnostic performance of T1ρ for differentiation between functional and fibrotic allografts was evaluated using receiver operating characteristic (ROC) analysis. Spearman correlations of T1ρ with Masson's trichrome-stained fractions and serum estimated glomerular filtration rate (eGFR) were assessed. RESULTS Higher T1ρ repeatability was found for cortex compared with medulla (mean CV T1ρ cortex 7.4%, medulla 13.3%). T1ρ values were significantly higher in the cortex of fibrotic vs. functional allografts (111.8 ± 17.2 msec vs. 99.0 ± 11.0 msec, P = 0.027), while there was no difference in medullary T1ρ values (122.6 ± 20.8 msec vs. 124.3 ± 20.8 msec, P = 0.789). Cortical T1ρ significantly correlated with Masson's trichrome-stained fractions (r = 0.515, P = 0.044) and eGFR (r = -0.546, P = 0.004), and demonstrated an area under the curve (AUC) of 0.77 for differentiating between functional and fibrotic allografts (sensitivity and specificity of 75.0% and 86.7%, using threshold of 106.9 msec). DATA CONCLUSION Our preliminary results suggest that T1ρ is a potential imaging biomarker of renal allograft fibrosis. These results should be verified in a larger study. LEVEL OF EVIDENCE 1 Technical Efficacy: Stage 1 J. Magn. Reson. Imaging 2019;50:1085-1091.
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Affiliation(s)
- Stefanie J Hectors
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Octavia Bane
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Paul Kennedy
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Fadi El Salem
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Madhav Menon
- Division of Renal Medicine, Recanati Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Maxwell Segall
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Rafael Khaim
- Division of Renal Medicine, Recanati Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Veronica Delaney
- Division of Renal Medicine, Recanati Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Sara Lewis
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Bachir Taouli
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Diagnostic efficacy and safety of ultrasound-guided kidney transplant biopsy using cortex-only view: a retrospective single-center study. Eur Radiol 2018; 29:5272-5279. [PMID: 30560360 DOI: 10.1007/s00330-018-5910-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Revised: 10/24/2018] [Accepted: 11/22/2018] [Indexed: 01/08/2023]
Abstract
PURPOSE Cortical biopsy is the cornerstone to reveal a cause of unexplained dysfunction of the kidney transplant. Nevertheless, only a few studies have reported the biopsy technique with its performance. We described a novel technique of ultrasound (US)-guided kidney transplant biopsy using cortex-only view and analyzed its diagnostic efficacy and safety. MATERIALS AND METHODS Between January 2014 and December 2016, a consecutive series of 188 patients who underwent US-guided kidney transplant biopsy using cortex-only view by an experienced radiologist were evaluated (mean age, 46.1 ± 12.5 years; range, 21-79 years). Biopsy time, biopsy distance, biopsy core number, and glomerular number per patient were recorded. Successful biopsy (e.g., adequate, 10 or more glomeruli; marginal, 7-9 glomeruli) and complication rates were investigated, using Banff criteria and Clavien-Dindo classification, respectively. RESULTS Mean biopsy time, distance, and core number were 20.6 ± 6.7 min (range, 10-44 min), 3.2 ± 0.7 cm (range, 2.1-5.4 cm), and 1.9 ± 0.3 (range, 1.0-3.0), respectively. Mean glomerular number per patient was 20.4 ± 10.0 (range, 0-54). Adequate and marginal biopsy rates were 87.2% (164/188) and 95.2% (179/188), respectively. There was no major complication requiring treatment (no patient with Clavien-Dindo grade 2 or greater complication), while there were self-limiting minor complications in 5 patients (overall complication rate, 2.7%). CONCLUSION US-guided biopsy using cortex-only view is feasible and safe in sampling cortical tissues of kidney transplant. KEY POINTS • Ultrasound (US)-guided kidney transplant biopsy using cortex-only view is feasible and safe. • Adequate and marginal biopsy rates were 87.2% and 95.2%, respectively. • No major complication requiring treatment occurred after biopsy.
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Patel MD, Young SW, Scott Kriegshauser J, Dahiya N. Ultrasound-guided renal transplant biopsy: practical and pragmatic considerations. Abdom Radiol (NY) 2018; 43:2597-2603. [PMID: 29427044 DOI: 10.1007/s00261-018-1484-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Sonographically guided percutaneous core biopsy of renal allografts has been performed for decades, providing valuable information in monitoring the status of normally functioning renal transplants as well as investigating the cause of renal transplant dysfunction. This article reviews practical aspects of biopsy technique using the cortical tangential approach, with consideration of factors that may influence biopsy success, including selection of biopsy device. Clinically important complications from renal transplant biopsy are uncommon; the most recent experience for one institution is analyzed in the context of existing evidence regarding the frequency and timing of these major complications, to understand pragmatic implications for peri-procedural care.
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Affiliation(s)
- Maitray D Patel
- Department of Radiology, Mayo Clinic Arizona, 5777 E. Mayo Blvd, Phoenix, AZ, 85054, USA.
| | - Scott W Young
- Department of Radiology, Mayo Clinic Arizona, 5777 E. Mayo Blvd, Phoenix, AZ, 85054, USA
| | - J Scott Kriegshauser
- Department of Radiology, Mayo Clinic Arizona, 5777 E. Mayo Blvd, Phoenix, AZ, 85054, USA
| | - Nirvikar Dahiya
- Department of Radiology, Mayo Clinic Arizona, 5777 E. Mayo Blvd, Phoenix, AZ, 85054, USA
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Abstract
Renal transplantation is the therapy of choice for patients with end-stage renal diseases. Improvement of immunosuppressive therapy has significantly increased the half-life of renal allografts over the past decade. Nevertheless, complications can still arise. An early detection of allograft dysfunction is mandatory for a good outcome. New advances in magnetic resonance imaging (MRI) have enabled the noninvasive assessment of different functional renal parameters in addition to anatomic imaging. Most of these techniques were widely tested on renal allografts in past decades and a lot of clinical data are available. The following review summarizes the comprehensive, functional MRI techniques for the noninvasive assessment of renal allograft function and highlights their potential for the investigations of different etiologies of graft dysfunction.
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