Osmanodja Bilgin, Muench Frédéric, Holderied Alexander, Budde Klemens, Fischer Thomas, Lerchbaumer Markus Herbert
Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany.
Department of Radiology, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany.
J Clin Med. 2022 Jul 27;11(15):4354. doi: 10.3390/jcm11154354.
Calcineurin inhibitors (CNIs) have improved short-term kidney allograft survival but are nephrotoxic and vasoconstrictive. Vasoconstriction is potentially reversible after switching from CNIs to belatacept. The kidney allograft shows optimal requirements for dynamic perfusion imaging using contrast-enhanced ultrasound (CEUS). We performed standardized CEUS in patients after switching from CNIs to belatacept for clinical indication to study the suitability of CEUS, in order to assess the effects of CNI cessation on kidney allograft perfusion. Eleven kidney transplant patients were enrolled from February 2020 until November 2020. Demographic, clinical, and laboratory parameters, as well as perfusion imaging, were assessed at baseline and 6 months after switching immunosuppression. Quantification of perfusion imaging on CEUS was performed using a post-processing software tool on uncompressed DICOM cine loops. After CNI cessation, estimated glomerular filtration rate increased by 4.8 mL/min/1.73 m (16%). Despite good quality of fit and comparable regions of interest in baseline and follow-up CEUS examinations, quantification of perfusion imaging showed a slightly improved cortical perfusion without reaching statistical significance after CNI cessation. This is the first study that systematically investigates the suitability of CEUS to detect changes of microvascular perfusion in kidney transplant recipients in vivo. No significant differences could be detected in perfusion measurements before and after CNI cessation.
钙调神经磷酸酶抑制剂（CNIs）改善了肾移植短期存活，但具有肾毒性和血管收缩作用。从CNIs转换为贝拉西普后，血管收缩可能是可逆的。肾移植对使用对比增强超声（CEUS）的动态灌注成像有最佳要求。我们对因临床指征从CNIs转换为贝拉西普的患者进行了标准化CEUS，以研究CEUS的适用性，从而评估停用CNIs对肾移植灌注的影响。从2020年2月至2020年11月招募了11名肾移植患者。在基线和转换免疫抑制6个月后评估人口统计学、临床和实验室参数以及灌注成像。使用后处理软件工具对未压缩的DICOM电影环进行CEUS灌注成像定量分析。停用CNIs后，估计肾小球滤过率增加了4.8 mL/min/1.73 m²（16%）。尽管基线和随访CEUS检查的拟合质量良好且感兴趣区域可比，但灌注成像定量分析显示停用CNIs后皮质灌注略有改善，但未达到统计学意义。这是第一项系统研究CEUS在体内检测肾移植受者微血管灌注变化适用性的研究。在停用CNIs前后的灌注测量中未检测到显著差异。
