Yun Sang Oh, Lee Kyo Won, Park Jae Berm, Kim Min Jung, Park Sung Yoon, Park Boram
Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Department of Surgery, Seoul Medical Center, Seoul, Korea.
Ultrasonography. 2023 Apr;42(2):238-248. doi: 10.14366/usg.22132. Epub 2022 Nov 7.
This study evaluated the role of donor kidney ultrasonography (US) for predicting functional kidney volume and identifying ideal kidney grafts in deceased donor kidney transplantation.
In total, 272 patients who underwent deceased donor kidney transplantation from 2000 to 2020 at Samsung Medical Center were enrolled. Donor kidney information (i.e., right or left) was provided to the radiologist who performed US image re-analysis. To binarize each kidney's ultrasound parameters, an optimal cutoff value for estimated glomerular filtration rate (eGFR) of less than 30 mL/min/1.73 m2 within 1 year after kidney transplantation was selected using the receiver operating characteristic curve with a specificity >60%. Cox regression analysis was performed for an eGFR less than 30 mL/min/1.73 m2 within 1 year after kidney transplantation and graft failure within 2 years after kidney transplantation.
The product of renal length and cortical thickness was a statistically significant predictor of graft function. The odds ratios of an eGFR less than 30 mL/min/1.73 m2 within a year after kidney transplantation and the hazard ratio of graft failure within 2 years after kidney transplantation were 5.91 (P=0.003) and 5.76 (P=0.022), respectively.
Preoperative US of the donor kidney can be used to evaluate donor kidney function and can predict short-term graft survival. An imaging modality such as US should be included in the donor selection criteria as an additional recommendation. However, the purpose of this study was not to narrow the expanded criteria but to avoid catastrophic consequences by identifying ideal donor kidneys using preoperative US.
本研究评估了供体肾超声检查（US）在预测功能性肾体积及识别脑死亡供体肾移植中理想肾移植物方面的作用。
共纳入2000年至2020年在三星医疗中心接受脑死亡供体肾移植的272例患者。将供体肾信息（即右肾或左肾）提供给进行超声图像重新分析的放射科医生。为使每个肾脏的超声参数二值化，使用特异性>60%的受试者工作特征曲线，选择肾移植术后1年内估计肾小球滤过率（eGFR）低于30 mL/min/1.73 m²的最佳截断值。对肾移植术后1年内eGFR低于30 mL/min/1.73 m²以及肾移植术后2年内移植物失败进行Cox回归分析。
肾长度与皮质厚度的乘积是移植物功能的统计学显著预测指标。肾移植术后1年内eGFR低于30 mL/min/1.73 m²的比值比以及肾移植术后2年内移植物失败的风险比分别为5.91（P=0.003）和5.76（P=0.022）。
供体肾术前超声检查可用于评估供体肾功能，并可预测短期移植物存活。应将超声等成像方式作为额外建议纳入供体选择标准。然而，本研究的目的不是缩小扩大标准，而是通过术前超声识别理想供体肾来避免灾难性后果。
