Published online Mar 18, 2024. doi: 10.5500/wjt.v14.i1.89255
Peer-review started: October 25, 2023
First decision: January 12, 2024
Revised: January 18, 2024
Accepted: February 27, 2024
Article in press: February 27, 2024
Published online: March 18, 2024
Processing time: 141 Days and 19.9 Hours
Detection of early chronic changes in the kidney allograft is important for timely intervention and long-term survival. Conventional and novel ultrasound-based investigations are being increasingly used for this purpose with variable results.
To compare the diagnostic performance of resistive index (RI) and shear wave elastography (SWE) in the diagnosis of chronic fibrosing changes of kidney allograft with histopathological results.
This is a cross-sectional and comparative study. A total of 154 kidney transplant recipients were included in this study, which was conducted at the Departments of Transplantation and Radiology, Sindh Institute of Urology and Transplan
The mean age of all patients was 35.32 ± 11.08 years. Among these, 126 (81.8%) were males and 28 (18.2%) were females. The mean serum creatinine in all patients was 2.86 ± 1.68 mg/dL and the mean estimated GFR was 35.38 ± 17.27 mL/min/1.73 m2. Kidney allograft biopsy results showed chronic changes in 55 (37.66%) biopsies. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of SWE for the detection of chronic allograft damage were 93.10%, 96.87%%, 94.73%, and 95.87%, respectively, and the diagnostic accuracy was 95.45%. For RI, the sensitivity, specificity, PPV, and NPV were 76.92%, 83.33%, 70.17%, and 87.62%, respectively, and the diagnostic accuracy was 81.16%.
The results from this study show that SWE is more sensitive and specific as compared to RI in the evaluation of chronic allograft damage. It can be of great help during the routine follow-up of kidney transplant recipients for screening and early detection of chronic changes and selecting patients for allograft biopsy.
Core Tip: Kidney transplantation is the treatment of choice for patients with end-stage kidney disease. Although short-term outcomes have improved markedly, chronic allograft damage remains a formidable challenge. Early detection of chronic changes is crucial for the optimal well-being of the graft. Biopsy is the gold standard but is invasive, and prone to sampling error and interobserver variation. The resistive index on Doppler is routinely used for the assessment of renal allograft status but its value in chronic renal allograft dysfunction is unclear. Shear wave sonoelastography is a novel imaging technique that has shown promising results in a number of studies.