Can transplant renal scintigraphy predict the duration of delayed graft function? A dual center retrospective study.
Can transplant renal scintigraphy predict the duration of delayed graft function? A dual center retrospective study.
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DOI：
10.1371/journal.pone.0193791
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发表时间：
2018
期刊：
影响因子：
3.7
通讯作者：
Slart RHJA
中科院分区：
文献类型：
--
作者：
Benjamens S;Pol RA;de Geus-Oei LF;de Vries APJ;Glaudemans AWJM;Berger SP;Slart RHJA
这项研究的重点是定量分析和定性分级肾显像与肾移植后移植肾功能延迟的预期持续时间的关系。对移植物功能持续时间延迟的更可靠的预测可能会导致移植后更具针对性和患者特异性的治疗方案。从2000年到2014年，有早期移植功能障碍的患者在移植后3天内进行了~(99m)Tc-MAG3肾核素显像，纳入双中心回顾性研究。对不同的定量指标(R20/3、TFS、cTER、MUC10)与一个新的指标(平均上斜率)相结合，对肾显像的时间-活度曲线进行定性分级。移植物功能延迟时间定义为基于透析的/功能性移植物功能延迟的天数。共纳入377例患者，平均年龄(±SD)52±14岁，其中58%为男性。共有274名患者(73%)经历了移植物功能≥延迟7天。定性分级预测移植物功能延迟≥7d的敏感性和特异性分别为87%和65%。结果最理想的定量指标是cTER(76%的敏感性，72%的特异性)和平均上升率(75%的敏感性，73%的特异性)。定性肾显像分级、定量指标CTER和平均上斜率预测移植肾功能延迟7天≥具有较高的敏感性。这一发现可能有助于支持临床医生和患者管理术后早期预期。然而，特异性是有限的，因此肾脏核素扫描不能可靠地帮助确定移植物功能延迟病程比预期更长的患者。
This study focused on the value of quantitatively analyzed and qualitatively graded renal scintigraphy in relation to the expected duration of delayed graft function after kidney transplantation. A more reliable prediction of delayed graft function duration may result in a more tailored and patient-specific treatment regimen post-transplantation. From 2000 to 2014, patients with early transplant dysfunction and a Tc-99m MAG3 renal scintigraphy, within 3 days post-transplantation, were included in a dual center retrospective study. Time-activity curves of renal scintigraphy procedures were qualitatively graded and various quantitative indices (R20/3, TFS, cTER, MUC10) were combined with a new index (Average upslope). The delayed graft function duration was defined as the number of days of dialysis-based/functional delayed graft function. A total of 377 patients were included, with a mean age (± SD) of 52 ± 14 years, and 58% were male. A total of 274 (73%) patients experienced delayed graft function≥ 7 days. Qualitative grading for the prediction of delayed graft function≥ 7 days had a sensitivity and specificity of respectively 87% and 65%. The quantitative indices with the most optimal results were cTER (76% sensitivity, 72% specificity), and Average upslope (75% sensitivity, 73% specificity). Qualitative renal scintigraphy grading and the quantitative indices cTER and Average upslope predict delayed graft function ≥ 7 days with a high sensitivity. This finding may help to support both clinicians and patients in managing early post-operative expectations. However, the specificity is limited and thus renal scintigraphy does not reliably help to identify patients in whom the course of delayed graft function is longer than anticipated.
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