Merkus J W, Hoitsma A J, van Asten W N, Koene R A, Skotnicki S H
Clinical Vascular Laboratory, University Hospital St Radboud Nijmegen, The Netherlands.
Transplantation. 1994 Sep 15;58(5):570-6. doi: 10.1097/00007890-199409150-00008.
During posttransplant acute renal failure (ARF), the diagnosis of allograft rejection constitutes a major problem. We evaluated the value of Doppler ultrasonography in identifying grafts at risk of rejection during ARF. In 184 recipients of a renal allograft, Doppler examinations were performed on the first and fifth postoperative day. Doppler spectra were quantitatively analyzed with a user-written computer program. Doppler findings were not used in clinical decision making. ARF was defined as a diuresis < 400 ml/24 hr and/or the necessity for dialysis. Doppler spectra obtained on the first day after transplantation showed a resistance index (RI) of 0.59 +/- 0.09 in recipients with immediately functioning cadaveric grafts (n = 123), while living related donor grafts (n = 20) showed a lower RI (0.55 +/- 0.07; P < 0.05). Grafts with ARF (n = 41) showed a considerably higher RI (0.67 +/- 0.13; P < 0.05). When grafts with a duration of ARF < or = 4 days (n = 17) were compared with ARF > 4 days (n = 24), RI was not significantly different (0.63 +/- 0.07 vs. 0.68 +/- 0.15; NS). However, the acceleration time of the systolic deflection of the spectrum waveform (Tmax) was shorter in grafts with ARF > 4 days (86 +/- 47 msec vs. 128 +/- 39 msec; P < 0.05). On the fifth day after transplantation, Doppler spectra in grafts with ARF > 4 days (n = 24) showed a Tmax < 90 msec in 9 patients, 8 of whom experienced rejection during ARF (positive predictive value, 8/9 = 89%). In the 15 patients with Tmax > or = 90 msec, only 2 rejections occurred (negative predictive value, 13/15 = 87%). For the RI (> 0.85), positive predictive value was 4/5 = 80% and negative predictive value (RI < or = 0.85) was 13/19 = 68%. In conclusion, a short acceleration time of the Doppler waveform on the first day after transplantation is associated with a longer duration of ARF. Quantitative analysis of Doppler spectra can be helpful in the identification of patients at risk for rejection and in the timing of allograft biopsy during ARF. Persistently short Tmax values on the fifth day after transplantation perform better in identifying grafts at risk of rejection than high RI values.
在移植后急性肾衰竭（ARF）期间，同种异体移植排斥反应的诊断是一个主要问题。我们评估了多普勒超声在识别ARF期间有排斥风险的移植物中的价值。在184例肾移植受者中，于术后第1天和第5天进行了多普勒检查。使用用户编写的计算机程序对多普勒频谱进行定量分析。多普勒检查结果未用于临床决策。ARF定义为尿量<400 ml/24小时和/或需要透析。移植后第1天获得的多普勒频谱显示，尸体肾移植立即功能良好的受者（n = 123）的阻力指数（RI）为0.59±0.09，而活体亲属供肾移植受者（n = 20）的RI较低（0.55±0.07；P<0.05）。发生ARF的移植物（n = 41）显示RI显著更高（0.67±0.13；P<0.05）。将ARF持续时间≤4天的移植物（n = 17）与ARF>4天的移植物（n = 24）进行比较时，RI无显著差异（0.63±0.07对0.68±0.15；无显著性差异）。然而，ARF>4天的移植物中频谱波形收缩期偏转的加速时间（Tmax）较短（86±47毫秒对128±39毫秒；P<0.05）。移植后第5天，ARF>4天的移植物（n = 24）中的多普勒频谱显示，9例患者的Tmax<90毫秒，其中8例在ARF期间发生排斥反应（阳性预测值，8/9 = 89%）。在Tmax≥90毫秒的15例患者中，仅发生2例排斥反应（阴性预测值，13/15 = 87%）。对于RI（>0.85），阳性预测值为4/5 = 80%，阴性预测值（RI≤0.85）为13/19 = 68%。总之，移植后第1天多普勒波形的加速时间短与ARF持续时间长有关。多普勒频谱的定量分析有助于识别有排斥风险的患者以及在ARF期间进行同种异体移植活检的时机。移植后第5天持续较短的Tmax值在识别有排斥风险的移植物方面比高RI值表现更好。
