Monitoring renal allograft rejection with duplex sonography.
Thirty-six renal allograft recipients were monitored by serial duplex Doppler ultrasound studies post-transplant and during early rejection.  A separate reproducibility study demonstrated no significant inter- or intra-operator variability in measurements of resistive index of an interlobar artery (RI) (2.1% [1.5%] and 3.2% [2.3%] respectively, mean [standard error] of coefficients of variance).  Twenty-one patients had rejection within 3 weeks of transplantation.  These grafts showed greater overall rises in the RI, from day 2 to day 5 post-transplant, than the grafts which had no rejection.  Eleven of the 21 patients required more than one course of methyl-prednisolone for persistent or recurring rejection. These grafts had higher RI on the day rejection was diagnosed (81 [7.3], median [interquartile range]) compared with the remaining 10 patients (68.6 [8.7]).  The 11 grafts with persistent rejection had higher RI (p less than 0.005, Mann-Whitney U-test) on day 2 post-transplant (76 [3.9]) compared with the 10 grafts successfully treated with a single course of methyl-prednisolone (63.2 [10.9]).  This study demonstrates that grafts with an RI of greater than 70 on day 2 post-transplant are likely to have rejection requiring additional treatment (sensitivity--100%, specificity--80%).  These patients may be candidates for earlier or alternative anti-rejection therapy.
University Department of Surgery, St. James's University Hospital, Leeds, U.K.
N J
NJ
London
M I
MI
Aldoori
J A
JA
Bates
V G
VG
Lodge
H C
HC
Irving
G R
GR
Giles
D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006084:Graft Rejection / Q000000981:diagnostic imaging* / Q000188:drug therapy; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods; D007668:Kidney / Q000473:pathology; D016030:Kidney Transplantation / Q000379:methods*; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use; D008875:Middle Aged; D011182:Postoperative Care / Q000379:methods; D011237:Predictive Value of Tests; D014463:Ultrasonography