title: Value of early diethylentriamine penta-acetic acid renograms in predicting late allograft outcomes.
abstract: BACKGROUND
  Tc-99m-diethylentriamine penta-acetic acid (DTPA) renal scintigraphy is useful, noninvasive diagnostic tool for the management and follow-up of the transplanted kidney. There have not been any studies of the predictive value of DTPA renal scintigraphy for short- and long-term allograft functions. Our aim was to reveal the significance of different perfusion-uptake patterns observed on Tc-99m-DTPA renal scintigraphy for long-term graft outcomes.
  
  
  METHODS
  We retrospectively analyzed 59 renal transplanted children (30 male and 29 female). All patients were underwent DTPA on posttransplant day 7. Perfusion- and function-related parameters of DTPA (the ratio of peak perfusion counts to plateau counts [P:PL], the ratio of counts at peak perfusion to counts at peak uptake [P:U], and glomerular filtration rate [GFR] calculated using commercially available software) were studied. The mean P:PL and P:U calculated using the half-moon-shaped background region of interest. A renal time activity curve was generated for evaluate perfusion- and function-related parameters. The patterns were classified and the value of these early DTPA parameters in predicting long-term graft function was analyzed.
  
  
  RESULTS
  The mean age of patients was 16.69 ± 4.77 years. The mean posttransplant follow-up time was 3.5 ± 0.4 years. Thirty-nine patients received living-related donor allografts and the remaining 20 were from deceased donors. Thirteen children suffered ≥ 1 acute rejection episode. Eight patients lost their grafts during follow-up. Mean GFR value at year 3 was 80.61 ± 39.03 mL/1.73 m(2) BSA/min. There was a significant difference for mean creatinine values at year 3 between recipients with normal perfusion and function and normal P:PL with decreased P:U patterns in early DTPA (P < .05). The normal P:PL with decreased P:U pattern is associated with lowest GFR value at posttransplant year 3. There was also a significant difference for mean GFR values at year 3 between recipients with normal perfusion and function and acute tubular necrosis (P < .05). Acute rejection episodes and graft loss were mostly seen in recipient with a decreased P:PL with or without decreased P:U pattern in early DTPA. The decreased P:PL with or without decreased P:U pattern may be associated with high risk of acute rejection episodes and graft loss.
  
  
  CONCLUSIONS
  Posttransplant early perfusion uptake patterns observed on Tc-99m-DTPA renal scintigraphy can be used as a long-term prognostic marker of poor renal outcomes. This would permit an opportunity for early intervention.
authors: Department of Pediatric Nephrology, Baskent University, Ankara, Turkey. Electronic address: esrabaskin@yahoo.com.
authors: E
authors: E
authors: Baskin
authors: K
authors: K
authors: Gulleroglu
authors: A
authors: A
authors: Aktas
authors: U S
authors: US
authors: Bayrakci
authors: E
authors: E
authors: Melek
authors: N
authors: N
authors: Uslu
authors: T
authors: T
authors: Bahceci
authors: A
authors: A
authors: Akdur
authors: G
authors: G
authors: Moray
authors: M
authors: M
authors: Haberal
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000367:Age Factors; D064591:Allografts; D002648:Child; D005260:Female; D005919:Glomerular Filtration Rate; D006084:Graft Rejection / Q000209:etiology / Q000503:physiopathology; D006085:Graft Survival; D006801:Humans; D007668:Kidney / Q000098:blood supply* / Q000503:physiopathology / Q000601:surgery*; D016030:Kidney Transplantation / Q000009:adverse effects; D019520:Living Donors; D008297:Male; D055420:Perfusion Imaging / Q000379:methods*; D011237:Predictive Value of Tests; D011866:Radioisotope Renography; D019275:Radiopharmaceuticals; D012079:Renal Circulation; D012189:Retrospective Studies; D012307:Risk Factors; D016284:Technetium Tc 99m Pentetate; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D019275:Radiopharmaceuticals; D016284:Technetium Tc 99m Pentetate