Li Xue, Wang Wei, Cheng Dongrui, Yu Yuanmeng, Wu Qianqian, Ni Xuefeng, Chen Jinsong, Zhang Longjiang, Wen Jiqiu
National Clinical Research Center of Kidney Disease, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province, China.
Department of Nephrology, Shanghai Tenth People's Hospital, Shanghai, China.
Clin Transplant. 2022 Nov;36(11):e14806. doi: 10.1111/ctr.14806. Epub 2022 Sep 4.
Transplant renal artery stenosis (TRAS) has been shown to reduce kidney perfusion leading to post-operative hypertension. We aimed to measure the perfusion and oxygenation changes in TRAS with arterial spin labeling (ASL) and blood oxygen level-dependent (BOLD) imaging, respectively.
In this single-center prospective study, a total of seven patients with TRAS and seven age- and sex-matched normal kidney transplant recipients underwent both ASL and BOLD imaging. Moreover, measurements of ASL and BOLD were also performed in five patients after successful angioplasty for TRAS.
Allograft cortical perfusion as measured by ASL in the TRAS group was significantly decreased as compared with normal control group (129.9 ± 46.6 ml/100 g vs. 202.4 ± 47.7 ml/100 g, P = .01). Interestingly, allograft oxygenation as indicated by R2* derived from BOLD in both the cortex (16.42 ± 1.90 Hz vs. 18.25 ± 4.34 Hz, P = .33) and the medulla (30.34 ± 2.35 Hz vs. 30.43 ± 6.85 Hz, P = .97) showed no statistical difference between the TRAS and normal control group. In addition, both cortical and medullary oxygenation remained unchanged despite significantly improved cortical perfusion in those undergone successful angioplasty.
Cortical and medullary oxygenation were preserved in the presence of reduced allograft perfusion in clinically significant TRAS. Prospective larger studies are needed to conclusively establish perfusion and oxygenation changes in TRAS.
移植肾动脉狭窄（TRAS）已被证明会减少肾脏灌注，导致术后高血压。我们旨在分别通过动脉自旋标记（ASL）和血氧水平依赖（BOLD）成像来测量TRAS中的灌注和氧合变化。
在这项单中心前瞻性研究中，共有7例TRAS患者和7例年龄及性别匹配的正常肾移植受者接受了ASL和BOLD成像。此外，对5例TRAS血管成形术成功后的患者也进行了ASL和BOLD测量。
与正常对照组相比，TRAS组通过ASL测量的移植肾皮质灌注显著降低（129.9±46.6 ml/100 g vs. 202.4±47.7 ml/100 g，P = 0.01）。有趣的是，无论是在皮质（16.42±1.90 Hz vs. 18.25±4.34 Hz，P = 0.33）还是髓质（30.34±2.35 Hz vs. 30.43±6.85 Hz，P = 0.97），TRAS组和正常对照组之间由BOLD得出的R2*所指示的移植肾氧合均无统计学差异。此外，尽管成功进行血管成形术的患者皮质灌注显著改善，但皮质和髓质的氧合均保持不变。
在具有临床意义的TRAS中，尽管移植肾灌注减少，但皮质和髓质氧合得以保留。需要进行前瞻性的更大规模研究来最终确定TRAS中的灌注和氧合变化。
