The value of Doppler ultrasound in predicting delayed graft function occurrence after kidney transplantation.
The aim of this study was to assess the predictive value of blood flow velocity and vascular resistance measured by Doppler ultrasound in terms of pulsatility index (PI) and resistive index (RI) respectively, in the occurrence of delayed graft function (DGF) after kidney transplantation. This prospective study enrolled kidney transplant recipients operated from January 2005 to April 2009 in the 1st Department of General, Oncological and Gastroenterological Surgery, Jagiellonian University Medical College, Kraków, Poland. The medical records of 53 kidney transplant recipients from deceased donors were reviewed. PI and RI values of the graft arcuate artery were calculated immediately after blood flow restoration and on the 1st, 2nd, 4th and 8th post-operative day. DGF was observed in 20 patients (37.7%), while 33 patients (62.3%) had immediate restoration of the kidney function. The mean intraoperative values of RI and PI from patients with DGF were significantly higher in comparison to patients without DGF (0.9 vs. 0.74, p <0.001; 1.76 vs. 1.54, p = 0.019, respectively). Post-operatively, the RI and PI values remained stable and significantly higher in DGF group. The highest sensitivity of RI to predict DGF occurrence was observed intraoperatively and on the first postoperative day, with values of 77.8% and 72.2%, respectively. The risk of DGF occurrence with intraoperative RI value ≥0.9 increased by 13-fold, and with intraoperative PI value ≥1.9 by 12-fold. This increase was even more prominent during the first post-operative day with RI value ≥0.9 or PI value ≥1.9 with 19-fold increase in the risk of DGF occurrence. According to our study, the utilization of Doppler ultrasound with measurement of hemodynamic parameters (PI, RI), play a crucial role in predicting the outcomes of kidney transplantation.
1st Department of General, Oncological and Gastroenterological Surgery, Jagiellonian University Medical College, Kopernika 40, Kraków, Poland.
Grzegorz
G
Mocny
Department of Anatomy, Jagiellonian University Medical College, Kopernika 12, Kraków, Poland. piotrbachul@gmail.com.
Piotr
P
Bachul
Ea-Sle
ES
Chang
Piotr
P
Kulig
D000328:Adult; D001783:Blood Flow Velocity; D051799:Delayed Graft Function / Q000453:epidemiology*; D005260:Female; D006801:Humans; D007668:Kidney / Q000098:blood supply* / Q000000981:diagnostic imaging; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D011044:Poland / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology*; D011184:Postoperative Period; D011446:Prospective Studies; D011673:Pulsatile Flow; D012077:Renal Artery / Q000000981:diagnostic imaging*; D018570:Risk Assessment; D018608:Ultrasonography, Doppler; D014655:Vascular Resistance
Doppler ultrasonography; delayed graft function (DGF); kidney transplantation; pulsatility index (PI); renal graft; resistive index (RI)