Lee Juhan, Oh Young Taik, Joo Dong Jin, Ma Bo Gyoung, Lee A-Lan, Lee Jae Geun, Song Seung Hwan, Kim Seung Up, Jung Dae Chul, Chung Yong Eun, Kim Yu Seun
From the Department of Transplantation Surgery, Severance Hospital, Yonsei University Health System (JL, DJJ, AL, JGL, SHS, YSK); The Research Institute for Transplantation, Yonsei University College of Medicine (DJJ, YSK); Department of Radiology, Severance Hospital, Yonsei University Health System (YTO, DCJ, YEC); Biostatistics Collaboration Unit, Yonsei University College of Medicine (BGM); and Department of Internal Medicine, Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea (SUK).
Medicine (Baltimore). 2015 Sep;94(39):e1590. doi: 10.1097/MD.0000000000001590.
Interstitial fibrosis and tubular atrophy (IF/TA) is a common cause of kidney allograft loss. Several noninvasive techniques developed to assess tissue fibrosis are widely used to examine the liver. However, relatively few studies have investigated the use of elastographic methods to assess transplanted kidneys. The aim of this study was to explore the clinical implications of the acoustic radiation force impulse (ARFI) technique in renal transplant patients. A total of 91 patients who underwent living donor renal transplantation between September 2010 and January 2013 were included in this prospective study. Shear wave velocity (SWV) was measured by ARFI at baseline and predetermined time points (1 week and 6 and 12 months after transplantation). Protocol biopsies were performed at 12 months. Instead of reflecting IF/TA, SWVs were found to be related to time elapsed after transplantation. Mean SWV increased continuously during the first postoperative year (P < 0.001). In addition, mixed model analysis showed no correlation existed between SWV and serum creatinine (r = -0.2426, P = 0.0771). There was also no evidence of a relationship between IF/TA and serum creatinine (odds ratio [OR] = 1.220, P = 0.7648). Furthermore, SWV temporal patterns were dependent on the kidney weight to body weight ratio (KW/BW). In patients with a KW/BW < 3.5 g/kg, mean SWV continuously increased for 12 months, whereas it decreased after 6 months in those with a KW/BW ≥ 3.5 g/kg.No significant correlation was observed between SWV and IF/TA or renal dysfunction. However, SWV was found to be related to the time after transplantation. Renal hemodynamics influenced by KW/BW might impact SWV values.
间质纤维化和肾小管萎缩（IF/TA）是同种异体肾移植失败的常见原因。为评估组织纤维化而开发的几种非侵入性技术被广泛用于检查肝脏。然而，相对较少的研究探讨了弹性成像方法在评估移植肾中的应用。本研究的目的是探讨声辐射力脉冲（ARFI）技术在肾移植患者中的临床意义。本前瞻性研究纳入了2010年9月至2013年1月期间接受活体供肾移植的91例患者。在基线和预定时间点（移植后1周、6个月和12个月）通过ARFI测量剪切波速度（SWV）。在12个月时进行方案活检。结果发现，SWV与移植后的时间有关，而非反映IF/TA。术后第一年平均SWV持续增加（P<0.001）。此外，混合模型分析显示SWV与血清肌酐之间无相关性（r=-0.2426，P=0.0771）。也没有证据表明IF/TA与血清肌酐之间存在关联（优势比[OR]=1.220，P=0.7648）。此外，SWV的时间模式取决于肾重与体重比（KW/BW）。在KW/BW<3.5 g/kg的患者中，平均SWV持续增加12个月，而在KW/BW≥3.5 g/kg的患者中，6个月后SWV下降。未观察到SWV与IF/TA或肾功能障碍之间存在显著相关性。然而，发现SWV与移植后的时间有关。受KW/BW影响的肾血流动力学可能会影响SWV值。
