[Doppler sonographic evaluation of the effectiveness of an antirejection treatment after kidney transplantation].
Data on 64 rejection reactions in 108 consecutive patients after renal transplantation (61 males, 47 females; mean age 42.8 +/- 12.9 years) were analysed to test what Doppler sonographic measurements can be used to predict whether a given drug regimen is able to suppress rejection. Results were compared with renal function and histological evidence of rejection. The >> pulsatility index << (PI), which is dependent on flow resistance, was determined by Doppler echocardiography: it increases on rejection (measurements made 2.0 +/- 1.1 days apart). The rejection reaction was successfully controlled by drugs (methylprednisolone, azathioprine and cyclosporin) in 44 patients (group 1), but not in 20 patients (group 2). PI before rejection (group 1: 1.8 +/- 0.5; group 2: 1.7 +/- 0.6), PI during histologically confirmed rejection (2.6 +/- 1.2 and 3.1 +/- 1.4, respectively), the size of difference between these values, and parameters of renal function provided no pointers to any drug efficacy in suppressing rejection. But individual changes in PI during suppression treatment proved to be of outstanding value (P < 0.00005). Signs of florid rejection at the end of treatment period correlated with a rising PI in 13 of 17 rejection episodes, while PI fell in only 7 of 47 episodes. Vascular signs of rejection tended to be poor predictors of rejection (P .028). - These findings indicate that serial Doppler sonography can be helpful in monitoring antirejection treatment.
Hollenbeck
M
M
Klinik für Nephrologie, Universität Düsseldorf.
Hetzel
G R
GR
Hilbert
N
N
Meusel
F
F
Willers
R
R
Grabensee
B
B
D000328:Adult; D000368:Aged; D001379:Azathioprine / Q000627:therapeutic use; D016572:Cyclosporine / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005260:Female; D006084:Graft Rejection / Q000000981:diagnostic imaging / Q000517:prevention & control*; D006801:Humans; D007165:Immunosuppression Therapy; D007668:Kidney / Q000098:blood supply / Q000000981:diagnostic imaging*; D016030:Kidney Transplantation; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D011673:Pulsatile Flow; D012079:Renal Circulation; D018615:Ultrasonography, Doppler, Color
D016572:Cyclosporine; D001379:Azathioprine; D008775:Methylprednisolone
Dopplersonographische Beurteilung der Effektivität einer Abstossungstherapie nach Nierentransplantation.