Application of ultrasound in follow-up of kidney transplant patients with delayed graft function

doi:10.3877/cma.j.issn.1672-6448.2021.12.013

Abstract

Abstract:

Objective

To evaluate the application value of ultrasound in the follow-up of kidney transplant recipients with delayed graft function (DGF).

Methods

A total of 158 patients who received allograft renal transplantation at the First Affiliated Hospital of Soochow University from October 2016 to October 2019 were retrospectively analyzed. According to the postoperative recovery of renal function and the need for hemodialysis, these patients were divided into two groups: DGF group and immediate graft function (IGF) group. Their ultrasonic and laboratory data were collected semiannually. The chi-square test was used to compare the difference of count data such as gender, dialysis method, and cause of donor death between the two groups. The difference of measurement data including age, cold ischemia time of donor kidney, lymphocyte toxicity test, serum creatinine, estimated glomerular filtration rate (eGFR), graft length, and renal artery resistance index (RI) was compared by the independent t-test. Data with a non-normal distribution were compared by the Mann-Whitney U test, including history time of chronic kidney disease, dialysis time, warm ischemia time, and peak flow velocity of transplanted renal artery.

Result

Among the patients included, 48 (31.0%) had DGF and 110 (69.0%) had IGF. There were no differences in gender, age, history of chronic kidney disease, dialysis method and time, donor age, cause of donor death, warm ischemia time, lymphocyte toxicity test, and some ultrasonographic features (P＞0.05 for all). The cold ischemia time in the DGF group was significantly longer than that of the IGF group [(15.47±4.90) h vs (13.43±4.43) h, t=2.534, P=0.012]. The level of serum creatinine in the DGF group was persistently higher than that of the IGF group. The eGFR in the IGF group was significantly higher than that of the DGF group at different time points (P＜0.05 for all). The RI in the DGF group was significantly higher than that of IGF group (P＜0.05 for all), except at 3 years after operation (t=1.932, P=0.063).

Conclusion

The occurrence of DGF after transplantation leads to worse graft function and higher renal artery resistance index. Ultrasound (renal artery RI) can provide more information about the condition of the transplanted kidneys for clinical evaluation.

Key words: Kidney transplantation, Ultrasound, Delayed graft function, Follow-up

Qingmin Fan, Fenglin Dong, Junchen Yan, Yajing Yang, Jie Wang, Xiaojing Wan. Application of ultrasound in follow-up of kidney transplant patients with delayed graft function[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2021, 18(12): 1197-1202.

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URL: https://chaosheng.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1672-6448.2021.12.013

https://chaosheng.cma-cmc.com.cn/EN/Y2021/V18/I12/1197

Figures/Tables 5

项目	DGF组（48例）	IGF组（110例）	统计值	P值
性别（例，男/女）	30/18	67/43	χ²=0.036	0.850
年龄（岁， $x ¯$ ±s）	41.65±10.54	41.19±10.60	t=0.253	0.800
病史时间［年，M（Q_R）］	7.0（3.0，11.0）	7.0（3.0，11.5）	Z=-0.097	0.923
透析方式（例）	46	106	χ²=577	0.447
血透	32	80
腹透	14	26
透析时间［月，M（Q_R）］	31（9，65）	26（8，70）	Z=-0.394	0.694
供体年龄（岁， $x ¯$ ±s）	37.88±10.86	35.56±10.32	t=1.054	0.294
供体死亡原因（例）			χ²=1.749	0.417
脑外伤	20	49
脑血管意外	20	35
其他	8	26
淋巴细胞毒性实验（%， $x ¯$ ±s）	2.45±0.60	2.49±0.58	t=0.456	0.649
供肾热缺血时间［min，M（Q_R）］	2（2，10）	2（2，10）	Z=-0.245	0.806
供肾冷缺血时间（h， $x ¯$ ±s）	15.47±4.90	13.43±4.43	t=2.534	0.012

项目	DGF组（48例）	IGF组（110例）	统计值	P值
性别（例，男/女）	30/18	67/43	χ²=0.036	0.850
年龄（岁， $x ¯$ ±s）	41.65±10.54	41.19±10.60	t=0.253	0.800
病史时间［年，M（Q_R）］	7.0（3.0，11.0）	7.0（3.0，11.5）	Z=-0.097	0.923
透析方式（例）	46	106	χ²=577	0.447
血透	32	80
腹透	14	26
透析时间［月，M（Q_R）］	31（9，65）	26（8，70）	Z=-0.394	0.694
供体年龄（岁， $x ¯$ ±s）	37.88±10.86	35.56±10.32	t=1.054	0.294
供体死亡原因（例）			χ²=1.749	0.417
脑外伤	20	49
脑血管意外	20	35
其他	8	26
淋巴细胞毒性实验（%， $x ¯$ ±s）	2.45±0.60	2.49±0.58	t=0.456	0.649
供肾热缺血时间［min，M（Q_R）］	2（2，10）	2（2，10）	Z=-0.245	0.806
供肾冷缺血时间（h， $x ¯$ ±s）	15.47±4.90	13.43±4.43	t=2.534	0.012

组别	例数	血肌酐（μmol/L）
组别	例数	术后6个月	术后12个月	术后18个月	术后24个月	术后30个月	术后36个月
DGF组	48	118.67±40.90	116.78±46.61	113.30±38.68	113.15±38.23	112.37±39.88	100.51±27.35
IGF组	110	101.32±38.42	98.81±31.99	95.81±31.70	90.95±26.94	86.91±27.11	84.69±25.81
t值		2.561	2.807	2.78	3.249	3.073	2.096
P值		0.011	0.006	0.006	0.002	0.003	0.041
组别	例数	eGFR［ml/（min·l.73 m²）］
组别	例数	术后6个月	术后12个月	术后18个月	术后24个月	术后30个月	术后36个月
DGF组	48	62.92±20.16	64.56±20.67	65.93±22.71	63.40±23.23	65.41±20.72	72.37±22.87
IGF组	110	75.51±24.49	75.43±21.14	79.62±27.13	80.83±20.41	84.41±22.61	86.90±22.94
t值		3.128	2.992	2.871	3.723	3.348	2.205
P值		0.002	0.003	0.005	0.000	0.001	0.032

组别	例数	肾长径（mm）
组别	例数	术后6个月	术后12个月	术后18个月	术后24个月	术后30个月	术后36个月
DGF组	48	118.91±8.13	119.70±8.83	119.38±9.39	116.00±6.64	123.71±2.98	116.45±7.71
IGF组	110	118.02±9.64	117.90±9.20	118.31±7.32	119.62±10.13	118.40±7.48	119.00±8.62
t值		0.536	1.084	0.445	1.550	1.811	0.821
P值		0.593	0.28	0.658	0.126	0.082	0.418
组别	例数	肾动脉峰值流速［cm/s，M（Q_R）］
组别	例数	术后6个月	术后12个月	术后18个月	术后24个月	术后30个月	术后36个月
DGF组	48	124.40（99.70，177.00）	125.00（112.00，163.00）	115.00（98.63，137.75）	107.00（92.20，152.00）	134.00（85.00，167.00）	106.00（89.30，130.00）
IGF组	110	144.00（107.00，182.00）	137.00（107.00，170.25）	146.50（104.38，176.25）	129.00（103.00，172.95）	139.50（115.25，207.75）	155.30（101.00，204.50）
Z值		-1.015	-1.045	-1.656	-1.497	-1.217	-1.349
P值		0.310	0.297	0.098	0.134	0.223	0.177
组别	例数	肾动脉阻力指数
组别	例数	术后6个月	术后12个月	术后18个月	术后24个月	术后30个月	术后36个月
DGF组	48	0.71±0.07	0.71±0.06	0.72±0.07	0.72±0.08	0.74±0.07	0.72±0.05
IGF组	110	0.66±0.07	0.68±0.07	0.67±0.05	0.68±0.06	0.68±0.05	0.68±0.06
t值		3.406	1.992	2.152	2.410	2.630	1.932
P值		0.001	0.048	0.036	0.019	0.014	0.063

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