Functional MRI detects perfusion impairment in renal allografts with delayed graft function.
Delayed graft function (DGF) after kidney transplantation is not uncommon, and it is associated with long-term allograft impairment. Our aim was to compare renal perfusion changes measured with noninvasive functional MRI in patients early after kidney transplantation to renal function and allograft histology in biopsy samples. Forty-six patients underwent MRI 4-11 days after transplantation. Contrast-free MRI renal perfusion images were acquired using an arterial spin labeling technique. Renal function was assessed by estimated glomerular filtration rate (eGFR), and renal biopsies were performed when indicated within 5 days of MRI. Twenty-six of 46 patients had DGF. Of these, nine patients had acute rejection (including borderline), and eight had other changes (e.g., tubular injury or glomerulosclerosis). Renal perfusion was significantly lower in the DGF group compared with the group with good allograft function (231 ± 15 vs. 331 ± 15 ml·min(-1)·100 g(-1), P < 0.001). Living donor allografts exhibited significantly higher perfusion values compared with deceased donor allografts (P < 0.001). Renal perfusion significantly correlated with eGFR (r = 0.64, P < 0.001), resistance index (r = -0.57, P < 0.001), and cold ischemia time (r = -0.48, P < 0.01). Furthermore, renal perfusion impairment early after transplantation predicted inferior renal outcome and graft loss. In conclusion, noninvasive functional MRI detects renal perfusion impairment early after kidney transplantation in patients with DGF.
Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany; hueper.katja@mh-hannover.de.
Katja
K
Hueper
Department of Nephrology, Hannover Medical School, Hannover, Germany;
Faikah
F
Gueler
Institute for Pathology, Hannover Medical School, Hannover, Germany;
Jan Hinrich
JH
Bräsen
Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany;
Marcel
M
Gutberlet
Department of Nephrology, Hannover Medical School, Hannover, Germany;
Mi-Sun
MS
Jang
Department of General, Abdominal and Transplant Surgery, Hannover Medical School, Hannover, Germany;
Frank
F
Lehner
Department of General, Abdominal and Transplant Surgery, Hannover Medical School, Hannover, Germany;
Nicolas
N
Richter
Department of Nephrology, Hannover Medical School, Hannover, Germany;
Nils
N
Hanke
Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany;
Matti
M
Peperhove
Section on Experimental Radiology, University of Tübingen, Tübingen, Germany; and.
Petros
P
Martirosian
Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany;
Susanne
S
Tewes
Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany;
Van Dai
VD
Vo Chieu
Institute for Biostatistics, Hannover Medical School, Hannover, Germany.
Anika
A
Großhennig
Department of Nephrology, Hannover Medical School, Hannover, Germany;
Hermann
H
Haller
Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany;
Frank
F
Wacker
Department of Nephrology, Hannover Medical School, Hannover, Germany;
Wilfried
W
Gwinner
Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany;
Dagmar
D
Hartung
D000328:Adult; D000368:Aged; D051799:Delayed Graft Function / Q000473:pathology* / Q000503:physiopathology*; D005260:Female; D005919:Glomerular Filtration Rate / Q000502:physiology; D006084:Graft Rejection / Q000473:pathology; D006085:Graft Survival / Q000502:physiology*; D006801:Humans; D007668:Kidney / Q000503:physiopathology*; D016030:Kidney Transplantation / Q000009:adverse effects / Q000379:methods; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D010477:Perfusion / Q000379:methods; D014184:Transplantation, Homologous / Q000009:adverse effects / Q000379:methods
MRI; delayed graft function; kidney transplantation; renal perfusion