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Abstract
Purpose
To compare the usefulness of Doppler ultrasonography and renal scintigraphy in the assessment of short- and long-term function of transplanted kidneys.
Materials and Methods
We retrospectively reviewed the cases of 79 patients who underwent Doppler ultrasonography and technetium-99m diethylene triamine pentaacetic acid renal scintigraphy on the same day, within 4 days of renal transplantation. Image parameters were evaluated for statistical differences.
Results
There was a strong positive correlation between the glomerular filtration rate (GFR) as measured by renal scintigraphy and the estimated GFR (eGFR) based on serum creatinine levels (correlation coefficient = 0.71). Scan grade according to the time-activity curve, resistive index, and end diastolic velocity showed moderate correlations with the eGFR (correlation coefficients = -0.557, -0.329, and 0.370, respectively) in the early post-transplantation period. The mean survival time was longer in patients with lower resistive indices (≤ 0.68, 54.9 months vs. > 0.68, 29.5 months) and lower pulsatility indices (≤ 1.32, 53.8 months vs. > 1.32, 28.7 months); however, there were no statistically significant differences in the long-term follow-up period (p = 0.121 for resistive index and p = 0.074 for pulsatility index).
Conclusion
Renal scintigraphy is a more sensitive method than Doppler ultrasonography for assessing transplanted kidney function in the early post-transplantation period. Doppler ultrasonography might reflect the long-term survival time. However, it is difficult to predict long-term renal function using either method.
Figures and Tables
Fig. 1
Flow chart summarizing the study method.
DTPA = diethylenetriaminepentaacetic acid, eGFR = estimated glomerular filtration rate, ROC = receiver operating characteristic, USG = ultrasonography
Fig. 2
Kaplan–Meier survival curves of renal dysfunction comparing cases with low vs. high resistive indices (≤ 0.68 vs. > 0.68). Mean survival time was longer (54.9 months vs. 29.5 months) in patients with lower resistive indices. However, the difference was not statistically significant (p = 0.121).
Table 1
Data of Laboratory Tests, Doppler Ultrasonography, and Renal Scintigraphy
Plus-minus values are mean ± standard deviation.
Cr = creatinine, EDV = end diastolic velocity, eGFR = estimated GFR, GFR = glomerular filtration rate, PI = perfusion index, PSV = peak systolic velocity, T1/2 = time from peak to 1/2 peak, Tmax = time to peak of the renogram, USG = ultrasonography, δP = time in seconds between the peaks of the iliac and graft curve
Table 2
Comparison of Imaging Parameters between Two Groups According to eGFR Level (30 mL/min per 1.73 m2) by Using Student's t-Test
Plus-minus values are mean ± standard deviation.
EDV = end diastolic velocity, eGFR = estimated GFR, GFR = glomerular filtration rate, PI = perfusion index, PSV = peak systolic velocity, T1/2 = time from peak to 1/2 peak, Tmax = time to peak of the renogram, USG = ultrasonography, δP = time in seconds between the peaks of the iliac and graft curve
Table 3
Comparison of Clinical and Imaging Parameters According to the Occurrence of Renal Dysfunction Using the Kaplan–Meier Survival Analysis
Doppler ultrasonography and renal scintigraphy parameters were divided according to cut-off value using ROC curve analysis.
CI = confidence interval, EDV = end diastolic velocity, GFR = glomerular filtration rate, PI = perfusion index, PSV = peak systolic velocity, ROC = receiver operating characteristic, T1/2 = time from peak to 1/2 peak, Tmax = time to peak of the renogram, δP = time in seconds between the peaks of the iliac and graft curve
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