Evaluation of renal transplant dysfunction by duplex Doppler sonography: a prospective study and review of the literature.
A disconcertingly wide variation exists in the literature as to the accuracy of duplex Doppler sonography in the detection of acute renal transplant rejection. Sensitivities range from 9% to 76%. In an attempt to explain the disparity of results, we undertook a double-blind prospective study of the accuracy of duplex Doppler ultrasound in the detection of acute rejection in renal transplants. We scanned 49 consecutive patients with a total of 65 biopsies; 46 biopsies in 33 consecutive patients were included in our study. In our population, the prevalence of acute rejection was 61% (28/46). Using a resistive index (RI) cutoff of greater than 0.90 based on the main renal artery flow pattern, the sensitivity of our test was 43%, with a 67% specificity. The positive predictive value was 67%. Our results are contrasted and compared with the published data from other groups in a critical survey of the literature. We conclude that duplex Doppler sonography alone is inadequate to evaluate acute rejection in renal transplants.
Department of Radiological Sciences, UCLA School of Medicine 90024.
R R
RR
Perrella
A J
AJ
Duerinckx
F N
FN
Tessler
G M
GM
Danovitch
A
A
Wilkinson
S
S
Gonzalez
A H
AH
Cohen
E G
EG
Grant
D000328:Adult; D000368:Aged; D001707:Biopsy, Needle; D004311:Double-Blind Method; D006084:Graft Rejection / Q000502:physiology*; D006801:Humans; D007668:Kidney / Q000098:blood supply* / Q000473:pathology; D016030:Kidney Transplantation; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012079:Renal Circulation; D012680:Sensitivity and Specificity; D014463:Ultrasonography / Q000379:methods*