Kobayashi Shuzo, Hidaka Sumi, Tanabe Kazunari
Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, Kanagawa, Japan.
Kidney Transplant and Robotic Surgery Center, Shonan Kamakura General Hospital, Kanagawa, Japan.
Clin Kidney J. 2024 Dec 10;18(1):sfae392. doi: 10.1093/ckj/sfae392. eCollection 2025 Jan.
Chronic kidney disease (CKD) is a significant risk factor for cerebrovascular disease. However, there is limited research on how successful living donor kidney transplantation (LDKT) affects cerebral blood flow (CBF). This study aims to comprehensively investigate how LDKT influences CBF across various brain levels and regions.
Data from 53 recipients between 2016 and 2020 were obtained from the VINTAGE study conducted at our hospital. CBF was measured by level and region using single-photon emission computed tomography (SPECT), according to the Talairach brain atlas. The primary endpoint was the mean difference in CBF before and 1-year post-LDKT. Subgroup analysis using traditional risk factors assessed the heterogeneity of the effect on CBF in the frontal lobe region.
LDKT improved blood flow in the anterior cerebral artery and middle cerebral artery but had less impact on the posterior cerebral artery. The most consistent improvements were observed in the frontal lobe region {left frontal lobe: -0.12 [95% confidence interval (CI) -0.18 to -0.05], < .001; right frontal lobe: -0.13 [95% CI -0.21 to -0.05], = .001}. Subgroup analysis showed a consistent effect of LDKT on frontal lobe CBF improvement, with no qualitative interaction observed.
LDKT contributes to the normalization of CBF, with improvement in anterior circulation and frontal lobe blood flow. To clarify the clinical significance of KT's CBF-improving effect, future studies should investigate the relationship between specific cognitive impairments (e.g. short-term memory, visuospatial ability, executive function) and CBF in each perfusion region.
慢性肾脏病（CKD）是脑血管疾病的一个重要危险因素。然而，关于活体供肾移植（LDKT）如何影响脑血流量（CBF）的研究有限。本研究旨在全面调查LDKT如何影响不同脑水平和区域的CBF。
2016年至2020年间，从我院进行的VINTAGE研究中获取了53例受者的数据。根据Talairach脑图谱，使用单光子发射计算机断层扫描（SPECT）按水平和区域测量CBF。主要终点是LDKT术前和术后1年CBF的平均差异。使用传统危险因素进行亚组分析，评估额叶区域对CBF影响的异质性。
LDKT改善了大脑前动脉和大脑中动脉的血流，但对大脑后动脉的影响较小。在额叶区域观察到最一致的改善{左额叶：-0.12 [95%置信区间（CI）-0.18至-0.05]，P <.001；右额叶：-0.13 [95% CI -0.21至-0.05]，P =.001}。亚组分析显示LDKT对额叶CBF改善有一致的效果，未观察到定性相互作用。
LDKT有助于CBF正常化，改善前循环和额叶血流。为了阐明肾移植改善CBF作用的临床意义，未来的研究应调查特定认知障碍（如短期记忆、视觉空间能力、执行功能）与每个灌注区域CBF之间的关系。
