Bau Jason T, Park Jennifer, Li Yanhong, Rampersad Christie, Kim S Joseph
Ajmera Transplant Centre, University Health Network, Toronto, Ontario, Canada.
Department of Medicine, Division of Transplant Medicine, University of Calgary, Calgary, Alberta, Canada.
Clin Transplant. 2024 Dec;38(12):e70048. doi: 10.1111/ctr.70048.
Kidney transplant ultrasonography is an important diagnostic tool in the care of transplant recipients. This modality of nonradiation-based imaging allows for precise and expedient reporting of allograft architecture, which can inform clinical decision-making. However, as with any diagnostic tool, overuse may lead to unnecessary interventions and costs on the healthcare system. To better understand the use of ultrasonography in hospitalized kidney transplant recipients and outcomes of subsequent interventions, we conducted a single-center retrospective study at a large transplant program in Ontario, Canada. We noted that over 30% of admissions resulted in a ultrasonographic survey within the first 24 h of presentation; however, most of these did not change clinical management or lead to a subsequent procedural intervention. Using multivariable logistic regression, we identified predictors for receiving an ultrasound, including time from transplantation, elevated serum creatinine and infectious diagnosis. Procedural interventions (e.g., drain or biopsy) resulted from less than 20% of all ultrasound investigations, with patients closer to the time of index transplant or with elevated serum creatinine values more likely to receive an intervention. In conducting a cost analysis, we estimated that approximately $80 000 CAD per year could be saved with more selective decisions on ultrasound requisitions. Overall, our results indicate that despite being an informative tool, the broad use of ultrasonography in the kidney transplant population may not yield significant changes to transplant care.
肾脏移植超声检查是移植受者护理中的一项重要诊断工具。这种基于非辐射的成像方式能够精确且快速地报告同种异体移植物的结构，从而为临床决策提供依据。然而，与任何诊断工具一样，过度使用可能会导致医疗系统出现不必要的干预措施和成本增加。为了更好地了解超声检查在住院肾脏移植受者中的使用情况以及后续干预的结果，我们在加拿大安大略省的一个大型移植项目中进行了一项单中心回顾性研究。我们注意到，超过30%的入院患者在就诊后的头24小时内接受了超声检查；然而，其中大多数检查并未改变临床管理，也未导致后续的程序性干预。通过多变量逻辑回归分析，我们确定了接受超声检查的预测因素，包括移植后的时间、血清肌酐升高以及感染诊断。所有超声检查中，不到20%的检查导致了程序性干预（如引流或活检），移植时间较近或血清肌酐值升高的患者更有可能接受干预。在进行成本分析时，我们估计，如果对超声检查申请做出更具选择性的决策，每年大约可以节省80000加元。总体而言，我们的结果表明，尽管超声检查是一种提供信息的工具，但在肾脏移植人群中广泛使用超声检查可能不会给移植护理带来显著改变。
