Normalization of Cerebral Blood Flow, Neurochemicals, and White Matter Integrity after Kidney Transplantation
Normalization of Cerebral Blood Flow, Neurochemicals, and White Matter Integrity after Kidney Transplantation
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DOI：
10.1681/asn.2020050584
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发表时间：
2021-01-01
影响因子：
13.6
通讯作者：
Gupta, Aditi
中科院分区：
文献类型：
--
作者：
Lepping, Rebecca J.;Montgomery, Robert N.;Gupta, Aditi
背景 CKD 与脑血流、脑神经化学浓度和白质完整性异常相关。其中每一个都与非 CKD 人群中的不良临床后果相关，这可能解释了 ESKD 中痴呆和中风的高患病率。由于肾移植后认知能力得到改善，因此比较肾移植前后的这些大脑异常可能会识别 ESKD 相关大脑异常的潜在可逆性。方法在这项针对 ESKD 患者和年龄匹配的健康对照的研究中，我们使用动脉自旋标记来评估肾移植对脑血流的影响，并使用磁共振波谱成像来测量脑神经化学浓度（N-乙酰天冬氨酸、胆碱、谷氨酸、谷氨酰胺、肌醇和总肌醇）。肌酸）。我们还通过扩散张量成像的分数各向异性 (FA) 和平均扩散率 (MD) 测量白质完整性。我们使用线性混合模型分析来比较移植前、移植后 3 个月和移植后 12 个月的纵向、重复脑磁共振成像测量结果，并将这些结果与健康对照的结果进行比较。 结果 研究参与者包括 29 名 ESKD 患者和 19 名对照； 22 名患者完成了移植后磁共振成像。与对照组相比，移植前患者的脑血流量较高（P=0.003），移植后则减少（P=0.003）。
Background CKD is associated with abnormalities in cerebral blood flow, cerebral neurochemical concentrations, and white matter integrity. Each of these is associated with adverse clinical consequences in the non-CKD population, which may explain the high prevalence of dementia and stroke in ESKD. Because cognition improves after kidney transplantation, comparing these brain abnormalities before and after kidney transplantation may identify potential reversibility in ESKD-associated brain abnormalities.Methods In this study of patients with ESKD and age-matched healthy controls, we used arterial spin labeling to assess the effects of kidney transplantation on cerebral blood flow and magnetic resonance spectroscopic imaging to measure cerebral neurochemical concentrations (N-acetylaspartate, choline, glutamate, glutamine, myo-inositol, and total creatine). We also assessed white matter integritymeasured by fractional anisotropy (FA) and mean diffusivity (MD) with diffusion tensor imaging. We used a linear mixed model analysis to compare longitudinal, repeated brain magnetic resonance imaging measurements before, 3 months after, and 12 months after transplantation and compared these findings with those of healthy controls.Results Study participants included 29 patients with ESKD and 19 controls; 22 patients completed post-transplant magnetic resonance imaging. Cerebral blood flow, which was higher in patients pretransplant compared with controls (P=0.003), decreased post-transplant (P