Surgical transplant physical examination: correlation of renal resistance index and biopsy-proven chronic allograft nephropathy.

Published

Journal Article

BACKGROUND: Chronic allograft nephropathy (CAN) remains the leading cause of late renal allograft loss that is minimally responsive to therapy once graft dysfunction is clinically evident. A screening test capable of identifying individuals at high risk for CAN would be a valuable adjunct to patient care, but to be cost effective, should be administered during routine evaluations by transplantation clinicians. STUDY DESIGN: We have compared the resistive index (RI) as measured by Doppler ultrasonography with subsequent biopsy findings on 91 renal allograft recipients who had a subsequent protocol-directed biopsy at least 3 months after renal transplant. All ultrasonography was performed by the transplantation surgical staff without involving the radiology department or a separate appointment time. RESULTS: Twenty-one patients had RI >/= 80 (average 621 days posttransplantation). Among these individuals, the subsequent incidence of CAN was 38%. Length of time between initial assessment of increased RI and biopsy-proved CAN averaged 233 days. The remaining 70 patients with RI < 80 had an incidence of CAN of 11.4% (p = 0.018). There were minimal complications from these biopsies. Sensitivity and specificity of an elevated RI in predicting CAN were 50% and 83%, respectively. The negative predicted value of an elevated RI in determination of CAN was 89%. CONCLUSIONS: These results suggest that elevated RI is an early predictor of histologically relevant CAN, possibly a result of burgeoning vasculopathy. The technical expertise required to make this appraisal is well within the capabilities of transplantation surgeons and trainees. Early evidence of CAN may allow for a targeted change in therapy before clinically significant injury. Ultrasonography should become a routine part of a transplantation clinic evaluation.

Full Text

Duke Authors

Cited Authors

  • Elster, EA; Hale, DA; Mannon, RB; Cendales, LC; Kleiner, D; Swanson, SJ; Kirk, AD

Published Date

  • April 2005

Published In

Volume / Issue

  • 200 / 4

Start / End Page

  • 552 - 556

PubMed ID

  • 15804469

Pubmed Central ID

  • 15804469

International Standard Serial Number (ISSN)

  • 1072-7515

Digital Object Identifier (DOI)

  • 10.1016/j.jamcollsurg.2004.12.009

Language

  • eng

Conference Location

  • United States