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Evaluation of the Graft Kidney in the Early Postoperative Period
Author(s) -
Goyal Ankur,
Hemachandran Naren,
Kumar Atin,
Sharma Raju,
Shamim Shamim Ahmed,
Bansal Virinder Kumar,
Das Chandan Jyoti,
Kandasamy Devasenathipathy,
Agarwal Sanjay Kumar,
Dinda Amit Kumar,
Seenu V.
Publication year - 2021
Publication title -
journal of ultrasound in medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.574
H-Index - 91
eISSN - 1550-9613
pISSN - 0278-4297
DOI - 10.1002/jum.15557
Subject(s) - medicine , acute tubular necrosis , renal function , urology , kidney , ultrasound , transplantation , renal artery , radiology , contrast enhanced ultrasound , kidney transplantation , surgery
Objectives To evaluate the various quantitative parameters of Doppler ultrasound, contrast‐enhanced ultrasound (CEUS), and shear wave elastography (SWE) of graft kidneys in the early postoperative period and to explore their utility in the diagnosis of parenchymal causes of graft dysfunction. Methods In this ethically approved study, consecutive patients who underwent renal transplantation from March 2017 to August 2018 were recruited, and those with urologic or vascular complications and those who denied consent were excluded. All patients underwent ultrasound with Doppler, SWE, CEUS (using sulfur hexafluoride), and renal scintigraphic examinations 3 to 10 days after transplantation. A composite reference standard was used, including the clinical course, renal function test results, urine output, and histopathologic results for graft dysfunction. Cortical SWE values, quantitative CEUS parameters (generated from a time‐intensity curve), and their ratios were analyzed to identify graft dysfunction and differentiate acute tubular necrosis (ATN) from acute rejection (AR). Results Of the 105 patients included, 19 developed graft dysfunction (18.1%; 12 ATN, 5 AR, and 2 drug toxicity) in the early postoperative period. The peak systolic velocity in the interpolar artery showed a significant difference between control and graft dysfunction groups ( P < .001) as well as between ATN and AR ( P = .019). Resistive indices and SWE did not show significant differences. Ratios of the time to peak showed a significant difference between control and graft dysfunction groups ( P < .05). The rise time and fall time of the large subcapsular region of interest and the rise time ratio were significantly different between ATN and AR ( P = .03). Conclusions Contrast‐enhanced ultrasound can be used to diagnose parenchymal causes of early graft dysfunction with reasonable diagnostic accuracy.