Hwang J K, Chun H J, Kim J M, Kwon K H, Kim Y K, Kim S D, Park S C, Choi B S, Kim J I, Yang C W, Kim Y S, Moon I S
Division of Transplantation Surgery, Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Transplant Proc. 2013 Oct;45(8):2925-30. doi: 10.1016/j.transproceed.2013.08.039.
Our objective was to evaluate the usefulness of three-dimensional (3-D) contrast-enhanced (CE) magnetic resonance angiography (MRA) to assess renal parenchyma, arterial inflow stenosis, and peritransplant fluid collections in the early period after kidney transplantation (KT). Between January 2010 and April 2011, we examined a consecutive series of 144 renal transplants using 3-D CE MRA at 14 days after KT. MRA showed parenchyma infarctions (n = 17, 11.8%), arterial inflow stenoses (n = 23, 16%), lymphoceles (n = 14, 9.7%), and hematomas (n = 6, 4.2%). The degree of renal transplant artery inflow stenosis was graded qualitatively based on diameter criterion; <50% = mild, 50% to 70% = moderate, and >70% = severe in 10 (6.9%), 5 (3.5%), and 8 (5.6%) subjects, respectively. The study recipients were divided into 3 groups according to the degree of renal artery inflow stenosis (group I: normal; group II: mild and moderate, <70%; group III: severe, >70%). Among group III patients who underwent digital subtraction angiography, 5 had percutaneous transluminal angioplasty or stenting performed after 1 month. Their mean resume creatinine levels at 1, 6, and 12 months after transplantation were not significantly different from those in the other groups (P = .391, .447, .110). The prevalence of graft loss (n = 2) was high in group III (P = .012), although the frequency of acute rejection episodes was not different among the groups (P = .890). The incidences of renal parenchyma infarction, peritransplant fluid collection and arterial inflow stenosis were unexpectedly high in the early period after KT. Thus, 3-D CE MRA provided a rapid global assessment of the renal parenchyma, transplant arterial system, and peritransplant fluid collection that can be helpful to detect or exclude many causes of renal transplant dysfunction.
我们的目的是评估三维（3-D）对比增强（CE）磁共振血管造影（MRA）在评估肾移植（KT）术后早期肾实质、动脉流入道狭窄及移植肾周液体积聚方面的实用性。在2010年1月至2011年4月期间，我们对144例肾移植患者在KT术后14天使用3-D CE MRA进行了连续检查。MRA显示实质梗死（n = 17，11.8%）、动脉流入道狭窄（n = 23，16%）、淋巴囊肿（n = 14，9.7%）和血肿（n = 6，4.2%）。根据直径标准对肾移植动脉流入道狭窄程度进行定性分级；<50%为轻度，50%至70%为中度，>70%为重度，分别有10例（6.9%）、5例（3.5%）和8例（5.6%）受试者。研究对象根据肾动脉流入道狭窄程度分为3组（I组：正常；II组：轻度和中度，<70%；III组：重度，>70%）。在接受数字减影血管造影的III组患者中，5例在1个月后进行了经皮腔内血管成形术或支架置入术。他们移植后1、6和12个月的平均恢复肌酐水平与其他组无显著差异（P = .391、.447、.110）。III组的移植肾丢失发生率（n = 2）较高（P = .012），尽管各组急性排斥反应发作频率无差异（P = .890）。KT术后早期肾实质梗死、移植肾周液体积聚和动脉流入道狭窄的发生率出乎意料地高。因此，3-D CE MRA可对肾实质、移植动脉系统和移植肾周液体积聚进行快速全面评估，有助于检测或排除肾移植功能障碍的多种原因。
