Contrast-enhanced ultrasonography-based renal blood perfusion in brain-dead donors predicts early graft function
Weiming He1, Yuguang Xu2, Chaoyang Gong1, Xiaozhen Liu2, Yuqiang Wu1, Xi Xie1, Jiazhen Chen1, Yi Yu1, Zhiyong Guo3, Qiang Sun1
1Organ Transplant Center, Zhongshan Hospital of Sun Yat-sen University, Zhongshan City People's Hospital, Zhongshan, China
2Ultrasound Imaging Department, Zhongshan Hospital of Sun Yat-sen University, Zhongshan City People's Hospital, Zhongshan, China
3Organ Transplant Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
Corresponding Author: Qiang Sun ,Tel: n/a, Fax: N/A, Email: sunqiang@zsph.com
Received: January 18, 2023;  Accepted: April 19, 2023.  Published online: April 19, 2023.
ABSTRACT
Purpose:
To quantify renal microcirculatory perfusion in brain-dead donors using contrast-enhanced ultrasonography (CEUS), and to establish an accurate, noninvasive, and convenient index for prediction of delayed graft function (DGF) post-transplantation.
Methods:
A total of 90 brain-dead donor kidneys(training group, n=60; validation group, n=30) examined between August 2020 and November 2022 were recruited in this prospective study. CEUS was performed on the kidneys of brain-dead donors 24 hours before organ procurement and time-intensity curves were constructed. The main measures were arrival time (AT), time to peak and peak intensity of kidney segmental arteries (KA), cortex (KC) and medulla. Recipients were divided into DGF and Non-DGF groups according to early post-transplant graft function. The area under the receiver operating characteristics curve (AUC) was used to assess diagnostic performance.
Results:
The arrival time of kidney segmental artery (ATKA) and cortex (ATKC), and the time interval (TI) between the time to peak of segmental artery and cortex (TI (KA-KC)) were identified as independent factors of DGF by multivariate stepwise regression analysis. A new index for the joint prediction model of three variables, contrast-enhanced ultrasonography/Kidney donor profile index (CEUS-KDPI), was founded, and had high accuracy (training group, AUC 0.91, sensitivity 90.5%, specificity 92.3%; validation group, AUC 0.84, sensitivity 75%, specificity 92.3%) for predicting DGF.
Conclusions:
CEUS-KDPI accurately predicts development of DGF after kidney transplantation. CEUS may be a potential non-invasive tool for bedside examination before organ procurement and may be used to predict early renal function after transplantation of kidneys from donation after brain death.
Keywords: Contrast-enhanced ultrasonography; brain-dead donors; delayed graft function; donor evaluation; kidney transplantation
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