Mani Laila-Yasmin, Cotting Jasna, Vogt Bruno, Eisenberger Ute, Vermathen Peter
Department of Nephrology and Hypertension, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland.
Departments of Biomedical Research and Radiology, University of Bern, 3010 Bern, Switzerland.
J Clin Med. 2022 Jun 8;11(12):3284. doi: 10.3390/jcm11123284.
The ZEUS study was a multi-center randomized controlled trial investigating the effect of early conversion from a ciclosporin-based to an everolimus-based regimen on graft function twelve months post-transplantation. In this investigator-initiated sub-study, functional magnetic resonance imaging (fMRI) of kidney grafts was prospectively performed to non-invasively assess differences in graft oxygenation, diffusion and perfusion between groups and time-points using diffusion-weighted imaging (DWI) and blood oxygen level-dependent (BOLD)-MRI. Sixteen patients underwent DWI and BOLD-MRI at months 4.5 and 12 post-transplantation on a 3 Tesla and 1.5 Tesla ( = 3) MR scanner. After exclusion due to image quality, outlier values or missing data, DWI was analyzed for ten subjects; BOLD for eight subjects. The diffusion coefficient ADC decreased in the CsA-treated group over time, whereas it increased in the EVE group ( = 0.046, medulla). The change in ADC from months 4.5 to 12 significantly differed between groups in the cortex ( = 0.033) and medulla ( = 0.019). In BOLD, cortico-medullary transverse relaxation rate R2* increased (decreased tissue oxygen) in the CsA-treated and decreased in EVE-treated groups over time. Similarly, R2* values at month 12 were higher in the CsA-treated group compared to the EVE-treated group. There was no significant difference for the perfusion fraction F. In conclusion, this prospective sub-study of the ZEUS trial suggests an impact of immunosuppressive regimen on fMRI parameters of the kidney graft.
ZEUS研究是一项多中心随机对照试验，旨在研究移植后12个月时从基于环孢素的方案早期转换为基于依维莫司的方案对移植肾功能的影响。在这项由研究者发起的子研究中，前瞻性地对肾移植进行功能磁共振成像（fMRI），以使用扩散加权成像（DWI）和血氧水平依赖（BOLD）-MRI非侵入性评估组间和时间点之间移植肾氧合、扩散和灌注的差异。16例患者在移植后4.5个月和12个月时在3特斯拉和1.5特斯拉（=3）磁共振扫描仪上接受了DWI和BOLD-MRI检查。由于图像质量、异常值或数据缺失而排除后，对10名受试者的DWI进行了分析；对8名受试者的BOLD进行了分析。环孢素治疗组的扩散系数ADC随时间下降，而依维莫司组则升高（=0.046，髓质）。4.5个月至12个月期间ADC的变化在皮质（=0.033）和髓质（=0.019）的组间存在显著差异。在BOLD中，环孢素治疗组的皮质-髓质横向弛豫率R2随时间增加（组织氧减少），依维莫司治疗组则下降。同样，环孢素治疗组在12个月时的R2值高于依维莫司治疗组。灌注分数F无显著差异。总之，ZEUS试验的这项前瞻性子研究表明免疫抑制方案对肾移植的fMRI参数有影响。
