Noninvasive evaluation of renal allograft fibrosis by transient elastography - a pilot study
Noninvasive evaluation of renal allograft fibrosis by transient elastography - a pilot study
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DOI：
10.1111/j.1432-2277.2010.01057.x
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发表时间：
2010-09-01
影响因子：
3.1
通讯作者：
Westhoff, Timm H.
中科院分区：
文献类型：
--
作者：
Arndt, Robert;Schmidt, Sven;Westhoff, Timm H.
慢性同种异体移植物损伤（CAI）是移植后第一年移植物衰竭的最常见原因。迄今为止，只有协议活检可以揭示亚临床疾病。瞬时弹性成像（TE）是一种新型的无创技术，在评估肝纤维化方面具有很高的可靠性。本研究评价TE评估移植肾纤维化的可行性。57名患者使用FibroScan（R）器械进行TE检查。对20例患者进行了活检。57例患者中有55例（96.5%）通过TE成功测量了脑实质硬度。僵硬度与间质纤维化程度显著相关（Pearson r：0.67，P：0.002，R2：0.45），与估计的肾小球滤过率（eGFR）呈负相关（Pearson r：-0.47，P：0.0003，R2：0.22）。eGFR > 50 ml/min的患者的僵硬度值显著低于eGFR < 50 ml/min的患者（22.2 +/- 11.0 vs. 37.1 +/- 14.2 kPa，P：0.0005）。CAI Banff 0-1级的刚度值与2级（P：0.008）和3级（P：0.046）有显著差异。通过TE测量的实质硬度反映了同种异体肾移植物中的间质纤维化。实质硬度的纵向评估可能是一个强大的工具，以确定CAI患者受益于活检和随后的适应免疫抑制方案。
P>Chronic allograft injury (CAI) is the most common cause of graft failure after the first year of transplantation. To date, only protocol biopsies can reveal subclinical disease. Transient elastography (TE) is a novel noninvasive technique that has demonstrated high reliability in the assessment of liver fibrosis. This study evaluates the feasibility of TE for the assessment of renal allograft fibrosis. Fifty-seven patients underwent TE by the FibroScan (R) device. Biopsies were performed in 20 patients. Measurement of parenchymal stiffness by TE was successful in 55 of 57 patients (96.5%). Stiffness was significantly correlated to the extent of interstitial fibrosis (Pearson r: 0.67, P: 0.002, R2: 0.45) and inversely related to estimated glomerular filtration rate (eGFR) (Pearson r: -0.47, P: 0.0003, R2: 0.22). Stiffness values of patients with an eGFR > 50 ml/min were significantly lower than in patients with an eGFR < 50 ml/min (22.2 +/- 11.0 vs. 37.1 +/- 14.2 kPa, P: 0.0005). The stiffness values of CAI Banff grades 0-1 differed significantly from grade 2 (P: 0.008) and grade 3 (P: 0.046). Parenchymal stiffness measured by TE reflects interstitial fibrosis in kidney allografts. A longitudinal assessment of parenchymal stiffness might be a powerful tool to identify patients with CAI who benefit from biopsy and consequent adaptation of the immunosuppressive regime.