Nakao T, Ushigome H, Nakamura T, Harada S, Koshino K, Suzuki T, Ito T, Nobori S, Yoshimura N
Department of Organ Transplantation and General Surgery, Kyoto Prefectural University of Medicine, Kajii-cho 465, Kamigyo-ku, Kyoto, Japan.
Department of Organ Transplantation and General Surgery, Kyoto Prefectural University of Medicine, Kajii-cho 465, Kamigyo-ku, Kyoto, Japan.
Transplant Proc. 2015 Apr;47(3):640-3. doi: 10.1016/j.transproceed.2014.12.034.
Chronic allograft injury (CAI) is one of the most important factors for graft failure after renal transplantation. Protocol biopsy is the most valuable tool for revealing subclinical renal allograft failure. Transient elastography (TE) is a noninvasive technique that has shown utility for the assessment of hepatic and renal fibrosis. This study sought to evaluate whether TE was a viable and effective method for the assessment of renal allograft failure.
Thirty-five patients underwent TE by Fibro Scan (Echosense, Paris, France). Biopsies were performed in 27 patients, allowing classification according to Banff chronic changes in the interstitium grade 0, grade 1 or grade 2.
Measurement of parenchymal stiffness was successful in 31 of 35 patients (91%). Stiffness was significantly correlated with interstitial fibrosis (P < .05) and inversely related with estimated glomerular filtration rate (eGFR; P < .05). Stiffness values of patients with eGFR > 50 mL/min were lower than those of patients with eGFR < 50 mL/min (P < .05). Patients classed as CAI Banff grade 0 had significantly less parenchymal stiffness than patients with Banff grade 1 or grade 2 CAI (P < .05). Parenchymal stiffness measured by TE reflected interstitial fibrosis in renal allograft.
Assessment of parenchymal renal allograft stiffness by TE was effective for identifying patients with CAI who may subsequently benefit from biopsy and modification of the immunosuppressive regimen. Assessment of parenchymal renal allograft stiffness can be effective for identifying patients with CAI. TE has the potential to reduce the number of renal allograft biopsies required for accurate assessment of CAI.
慢性移植肾损伤（CAI）是肾移植后移植肾失功的最重要因素之一。方案活检是揭示亚临床移植肾失功最有价值的工具。瞬时弹性成像（TE）是一种非侵入性技术，已显示出在评估肝纤维化和肾纤维化方面的应用价值。本研究旨在评估TE是否是评估移植肾失功的一种可行且有效的方法。
35例患者接受了法国巴黎Echosense公司的Fibro Scan进行的TE检查。27例患者进行了活检，可根据班夫间质慢性变化分为0级、1级或2级。
35例患者中有31例（91%）成功测量了实质硬度。硬度与间质纤维化显著相关（P <.05），与估计肾小球滤过率（eGFR）呈负相关（P <.05）。eGFR>50 mL/min患者的硬度值低于eGFR<50 mL/min的患者（P <.05）。班夫分级为0级的CAI患者的实质硬度明显低于班夫分级为1级或2级的CAI患者（P <.05）。TE测量的实质硬度反映了移植肾的间质纤维化。
通过TE评估移植肾实质硬度可有效识别可能随后从活检和调整免疫抑制方案中获益的CAI患者。评估移植肾实质硬度可有效识别CAI患者。TE有可能减少准确评估CAI所需的移植肾活检次数。
