Shebel Haytham M, Akl Ahmed, Dawood Ahmed, El-Diasty Tarek A, Shokeir Ahmed A, Ghoneim Mohamed A
Department of Nephrology, Urology and Nephrology Center, Mansoura, Egypt.
Saudi J Kidney Dis Transpl. 2014 Jul;25(4):733-40. doi: 10.4103/1319-2442.134948.
To evaluate the role of power Doppler in the identification and differentiation between acute renal transplant rejection and acute tubular necrosis (ATN), we studied 67 live donor renal transplant recipients. All patients were examined by spectral and power Doppler sonography. Assessment of cortical perfusion (CP) by power Doppler was subjective, using our grading score system: P0 (normal CP); homogenous cortical blush extending to the capsule, P1 (reduced CP); cortical vascular cut-off at interlobular level, P2 (markedly reduced CP); scattered cortical color flow at the interlobar level. Renal biopsies were performed during acute graft dysfunction. Pathological diagnoses were based on Banff classification 1997. The Mann- Whitney test was used to test the difference between CP grades with respect to serum creatinine (SCr), and resistive index (RI). For 38 episodes of acute graft rejection grade I, power Doppler showed that CP was P1 and RI ranging from 0.78 to 0.89. For 21 episodes of acute graft rejection grade II, power Doppler showed that CP was P1, with RI ranging from 0.88 to >1. Only one case of grade III rejection had a CP of P2. Twelve biopsies of ATN had CP of P0 and RI ranging from 0.80 to 0.89 There was a statistically significant correlation between CP grading and SCr (P <0.01) as well as between CP grading and RI (P <0.05). CP grading had a higher sensitivity in the detection of early acute rejection compared with RI and cross-sectional area measurements. We conclude that power Doppler is a non-invasive sensitive technique that may help in the detection and differentiation between acute renal transplant rejection and ATN, particularly in the early post-transplantation period.
为评估能量多普勒在鉴别急性肾移植排斥反应与急性肾小管坏死（ATN）中的作用，我们对67例活体供肾肾移植受者进行了研究。所有患者均接受了频谱和能量多普勒超声检查。采用我们的分级评分系统对能量多普勒评估的皮质灌注（CP）进行主观评价：P0（正常CP）；均匀的皮质红晕延伸至肾包膜，P1（CP降低）；小叶间水平的皮质血管中断，P2（CP显著降低）；叶间水平散在的皮质血流信号。在急性移植肾功能障碍期间进行肾活检。病理诊断依据1997年班夫分类法。采用曼-惠特尼检验来检测CP分级在血清肌酐（SCr）和阻力指数（RI）方面的差异。对于38例I级急性移植排斥反应，能量多普勒显示CP为P1，RI范围为0.78至0.89。对于21例II级急性移植排斥反应，能量多普勒显示CP为P1，RI范围为0.88至>1。仅1例III级排斥反应的CP为P2。12例ATN活检的CP为P0，RI范围为0.80至0.89。CP分级与SCr之间（P<0.01）以及CP分级与RI之间（P<0.05）存在统计学显著相关性。与RI和截面积测量相比，CP分级在检测早期急性排斥反应方面具有更高的敏感性。我们得出结论，能量多普勒是一种无创性敏感技术，可能有助于鉴别急性肾移植排斥反应与ATN，尤其是在移植后早期。
