Limited value of 111-indium platelet scintigraphy in renal transplant patients receiving cyclosporine.
Since the differential diagnosis between cyclosporine (CyA) nephrotoxicity and acute graft rejection is still a problem in clinical routine, we studied retrospectively the value of 111-indium (In) platelet scintigraphy in 53 patients immunosuppressed with CyA and prednisolone. Autologous platelets were labeled once per week. After daily gamma camera imaging, the platelet deposition in the graft was expressed as platelet-uptake ratio (PUR). The patients were monitored during the first 4-6 weeks after surgery. PUR values measured during an episode of graft dysfunction were compared to the histological diagnosis. The PUR of well-functioning and stable grafts measured 1.07 +/- 0.11 (mean +/- SD). The 111-In platelet scintigraphy failed to register acute interstitial rejection. The PUR values in episodes of chronic vascular rejection, of acute tubular necrosis due to prolonged ischemia times, of tubular CyA nephrotoxicity and of cytomegalovirus (CMV) infection did not differ from the PUR of well-functioning and stable grafts as well. The PUR was significantly increased to 1.48 +/- 0.26 because of a marked platelet deposition in the graft in episodes of acute vascular rejection. In 4 cases of microvascular CyA nephrotoxicity the same phenomenon of significantly increased PUR (1.33 +/- 0.18), could be encountered, too. Two of these 4 cases resembled the hemolytic uremic syndrome (HUS). The value of PUR measurement for diagnosis of acute vascular rejection and microvascular CyA nephrotoxicity together, was: sensitivity 0.62, specificity 0.95, predictive value of positive result 0.64, predictive value of negative result 0.94.(ABSTRACT TRUNCATED AT 250 WORDS)
Leithner
C
C
Schwarz
M
M
Sinzinger
H
H
Ulrich
W
W
D000293:Adolescent; D000328:Adult; D001706:Biopsy; D001792:Blood Platelets; D003524:Cyclosporins / Q000009:adverse effects / Q000627:therapeutic use*; D003937:Diagnosis, Differential; D005260:Female; D006084:Graft Rejection; D006801:Humans; D006912:Hydroxyquinolines; D007204:Indium; D007668:Kidney / Q000000981:diagnostic imaging / Q000187:drug effects; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D009942:Organometallic Compounds; D015125:Oxyquinoline / Q000031:analogs & derivatives; D011239:Prednisolone / Q000627:therapeutic use; D011868:Radioisotopes; D011877:Radionuclide Imaging; D012189:Retrospective Studies
D003524:Cyclosporins; D006912:Hydroxyquinolines; D009942:Organometallic Compounds; D011868:Radioisotopes; D007204:Indium; C032950:indium oxine; D015125:Oxyquinoline; D011239:Prednisolone