Clinical Application of Multimodal Ultrasound in Monitoring DBD Renal Transplantation

Wandong YANG; Yongfeng LI; Chunhua XIAO; Huimin PU; Hong LI; Wei YANG; Yan SHEN; Shilan DING; Chengcheng ZHU; Xiangfeng MIN

doi:10.12259/j.issn.2095-610X.S20220321

Volume 43 Issue 3

Mar. 2022

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Article Navigation > Journal of Kunming Medical University > 2022 > 43(3): 113-122

Wandong YANG, Yongfeng LI, Chunhua XIAO, Huimin PU, Hong LI, Wei YANG, Yan SHEN, Shilan DING, Chengcheng ZHU, Xiangfeng MIN. Clinical Application of Multimodal Ultrasound in Monitoring DBD Renal Transplantation[J]. Journal of Kunming Medical University, 2022, 43(3): 113-122. doi: 10.12259/j.issn.2095-610X.S20220321

Citation:

Wandong YANG, Yongfeng LI, Chunhua XIAO, Huimin PU, Hong LI, Wei YANG, Yan SHEN, Shilan DING, Chengcheng ZHU, Xiangfeng MIN. Clinical Application of Multimodal Ultrasound in Monitoring DBD Renal Transplantation[J]. Journal of Kunming Medical University, 2022, 43(3): 113-122. doi: 10.12259/j.issn.2095-610X.S20220321

Citation:

Wandong YANG, Yongfeng LI, Chunhua XIAO, Huimin PU, Hong LI, Wei YANG, Yan SHEN, Shilan DING, Chengcheng ZHU, Xiangfeng MIN. Clinical Application of Multimodal Ultrasound in Monitoring DBD Renal Transplantation[J]. Journal of Kunming Medical University, 2022, 43(3): 113-122. doi: 10.12259/j.issn.2095-610X.S20220321

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Clinical Application of Multimodal Ultrasound in Monitoring DBD Renal Transplantation

doi: 10.12259/j.issn.2095-610X.S20220321

1.
Dept. of Ultrasound，Calmette Hospital Affiliated to Kunming Medical University，Kunming Yunnan 650224
2.
Dept. of Ultrasound，Kunming Second People’s Hospital，Kunming Yunnan 650224，China

Received Date: 2022-01-16
Available Online: 2022-02-18
Publish Date: 2022-03-22

Abstract

Abstract

Objective To evaluate the value of multimodal ultrasound in monitoring renal function and postoperative complications of DBD transplantation. Methods 67 cases of brain dead organ donor kidney transplantation （DBD） in Ganmei Hospital Affiliated to Kunming Medical University from July 2019 to June 2021 were selected to evaluate the transplanted kidney by multimodal ultrasound. The transplanted kidneys were divided into normal function group and abnormal group according to blood creatinine. The abnormal group was divided into acute rejection group, chronic rejection group, viral nephropathy group, fibrosis group and drug injury group according to puncture pathology. The correlation between arterial peak velocity （PSV）, diastolic velocity （EDV）, resistance index （RI） and serum creatinine was analyzed. To compare the diagnostic efficacy of contrast-enhanced ultrasound with pathology or DSA in renal transplantation complications, and to analyze the correlation between contrast-enhanced ultrasound parameters and renal transplantation function. Rank sum test was used to compare the young’ s modulus between abnormal group and normal group. The ROC curve was drawn, and the young’ s modulus at the highest yoden index was used as the cut-off value to distinguish normal and abnormal transplanted kidneys, and the corresponding sensitivity and specificity were calculated. Results The correlation between blood flow parameters of transplanted kidney and serum creatinine was general, and the correlation coefficients were less than 0.5. The arrival time and peak time of chronic rejection group （8 cases） were significantly longer than those of normal group （10 cases）, and the difference was statistically significant. Two cases of pseudoaneurysm, two cases of graft ischemia and one case of graft venous thrombosis were diagnosed by contrast-enhanced ultrasonography, which were confirmed by pathology or DSA. According to the serum creatinine value, 62 cases of transplanted kidney were divided into 22 cases in the normal group and 40 cases in the abnormal group （5 cases in the acute rejection group, 11 cases in the chronic rejection group, 10 cases in the viral nephropathy group, 10 cases in the fibrosis group and 4 cases in the drug injury group）. The RI of renal aorta in acute rejection group was higher than that in normal group, the RI of interlobar artery in chronic rejection group was higher than that in normal group, the EDV of main and interlobar artery was lower than that in normal group, the PSV of interlobar artery was lower than that in normal group, and the main PSV of fibrosis group was lower than that in normal group. The above differences were statistically significant （P < 0.05）; There was no significant difference in parameters between viral nephropathy, drug injury group and normal group （P > 0.05）. The young’ s modulus of ste in abnormal group and normal group were 22.550 （17.1, 28.1） and 13.370 （11.8, 15.9） kPa, respectively （P < 0.01）. When the cut-off value = 17.31 kpa, the sensitivity and specificity of shear wave elastography in the diagnosis of renal allograft lesions were 75% and 91%. The young’ s modulus of STQ in abnormal group and normal group were 21.760 （16.4, 33.4） and 13.870 （10.5, 16.8） kPa, respectively, with significant difference （P < 0.01）. When the cut-off value = 18.16 kpa, the sensitivity and specificity of shear wave elastography in the diagnosis of renal allograft lesions were 70% and 91%. The young’ s modulus of ste in acute rejection group, chronic rejection group, viral nephropathy group, fibrosis group and drug injury group were 13.370 （11.8, 15.9）, 15.550 （13.4, 16.6）, 26.870 （21.6, 38.6）, 26.660 （19.5, 34.2）, 16.310 （13.2, 23.1） and 27.690 （24.6, 29.2） respectively; The young’ s modulus values of STQ were 13.870 （10.5, 16.8）, 16.330 （15.5, 17.4）, 23.780 （19.2, 40.7）, 22.760 （19.9, 36.0）, 16.540 （14.5, 26.0） and 33.355 （29.1, 35.4） respectively. There was significant difference among the groups （P < 0.05）. The chronic rejection group, viral nephropathy group and drug injury group were significantly higher than those in the normal group （P < 0.05）, but there was no significant difference between the acute rejection group, fibrosis group and the normal group （P > 0.05）. The elastic value of viral nephropathy was higher than that of acute rejection, ste: 26.660 （19.5, 34.2） vs 15 550 （13.4, 16.6）kPa （P<0.01）, STQ: 22.760 （19.9, 36.0）vs16. 330 （15.5, 17.4） kPa （P < 0.01）, the difference was statistically significant. Conclusions The blood flow parameters of transplanted kidney can early evaluate the function of transplanted kidney, and have guiding significance for the differentiation of normal, acute and chronic rejection and viral nephropathy. Contrast-enhanced ultrasound has guiding significance in the differentiation of renal transplant complications. Elastography can noninvasively evaluate the hardness of transplanted kidney, and has a certain clinical value in the timely detection of transplanted kidney complications and differential diagnosis.
- Multimodal ultrasound,
- Kidney transplantation,
- Complication,
- Graft function,
- Rejection

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