两次连续移植后肾闪烁显像检查的临床价值有限。

Limited clinical value of two consecutive post-transplant renal scintigraphy procedures.

机构信息

Department of Radiology, Division of Nuclear Medicine, Leiden University Medical Center, Leiden University, Leiden, The Netherlands.

Department of Surgery, Division of Transplant Surgery, University Medical Center Groningen, University of Groningen, P.O. Box 30 001, 9700 RB, Groningen, The Netherlands.

出版信息

Eur Radiol. 2020 Jan;30(1):452-460. doi: 10.1007/s00330-019-06334-1. Epub 2019 Jul 23.

DOI:10.1007/s00330-019-06334-1

PMID:31338652

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6890596/

Abstract

OBJECTIVES

Duration of delayed graft function (DGF) and length of hospital stay (LOS) are outcomes of interest in an era that warrants increased efficacy of transplant care whereas renal allografts originate increasingly from marginal donors. While earlier studies investigate the predictive capability of a single renal scintigraphy, this study focuses on the value for both DGF duration and LOS of consecutively performed scintigraphies.

METHODS

From 2011 to 2014, renal transplant recipients referred for a Tc-99m MAG3 renal scintigraphy were included in a single-center retrospective study. Primary endpoints were DGF duration and LOS. Both the first (≤ 3 days) and second scintigraphies (3-7 days after transplantation) were analyzed using a 4-grade qualitative scale and quantitative indices (TFS, cTER, MUC10, average upslope).

RESULTS

We evaluated 200 first and 108 (54%) consecutively performed scintigraphies. The Kaplan-Meier curves for DGF duration and qualitative grading of the first and second scintigraphy showed significant differences between the grades (p < 0.01). The Kaplan-Meier curve for the delta grades between these procedures (lower, equal, or higher grade) did not show significant differences (p = 0.18). Multivariate analysis showed a significant association between the qualitative grades, from the first and second scintigraphy, and DGF duration, HR 1.8 (1.4-2.2, p < 0.01) and 2.8 (1.8-4.3, p < 0.01), respectively.

CONCLUSIONS

Qualitative grades of single renal scintigraphies, performed within 7 days after transplantation, can be used to make a reliable image-guided decision on the need for dialysis and to predict LOS. A consecutive renal scintigraphy, however, did not show an additional value in the assessment of DGF.

KEY POINTS

• Post-transplant renal scintigraphy procedures provide information to predict delayed graft function duration and length of hospital stay. • Performing two consecutive renal scintigraphy procedures within 1 week after transplantation does not strengthen the prediction of delayed graft function duration and length of hospital stay. • Single renal scintigraphy procedures can be used to provide clinicians and patients with a reliable indication of the need for dialysis after transplantation and the expected duration of hospitalization.

摘要

目的

在需要提高移植护理效果的时代，延迟移植物功能（DGF）持续时间和住院时间（LOS）是人们关注的结果，而肾脏同种异体移植物越来越多地来自边缘供者。虽然早期的研究调查了单次肾闪烁显像的预测能力，但本研究侧重于连续进行的闪烁显像对 DGF 持续时间和 LOS 的价值。

方法

从 2011 年到 2014 年，因 Tc-99m MAG3 肾闪烁显像而转介的肾移植受者被纳入一项单中心回顾性研究。主要终点是 DGF 持续时间和 LOS。使用 4 级定性评分和定量指数（TFS、cTER、MUC10、平均斜率）对第一次（≤3 天）和第二次闪烁成像进行分析。

结果

我们评估了 200 例首次和 108 例（54%）连续进行的闪烁成像。DGF 持续时间和第一次和第二次闪烁成像定性分级的 Kaplan-Meier 曲线显示分级之间存在显著差异（p<0.01）。这些程序之间的 delta 分级（较低、相等或较高分级）的 Kaplan-Meier 曲线没有显示出显著差异（p=0.18）。多变量分析显示，第一次和第二次闪烁成像的定性分级与 DGF 持续时间之间存在显著关联，HR 分别为 1.8（1.4-2.2，p<0.01）和 2.8（1.8-4.3，p<0.01）。