title: The Serial Duplex Index Improves Differential Diagnosis of Acute Renal Transplant Dysfunction.
abstract: OBJECTIVE
  Renal duplex sonography represents a standard noninvasive diagnostic procedure to demonstrate morphologic changes in acute kidney transplant dysfunction. We investigated whether a newly developed serial duplex index (SDI) can differentiate between acute cellular rejection and acute vascular rejection more effectively than the established Doppler parameters of the resistive index (RI) and pulsatility index (PI) in recently transplanted patients.
  
  
  METHODS
  Serial duplex scans of patients with histologically proven acute tubular necrosis (n = 25), acute cellular rejection (n = 28), acute vascular rejection (n = 18), and normal graft function (n = 50, partially protocol biopsied) were retrospectively analyzed. For each patient, the RI, PI, and cortex-pelvis proportion (CPP) were included from the day of biopsy (t0) and 3 to 7 days before biopsy (t-1). The sequential CPP ratio (CPPt0/CPPt-1), RI ratio (RIt0/RIt-1), and PI ratio (PIt0/Pit-1) were determined. The SDI was calculated as: RI ratio × PI ratio/CPP ratio. The diagnostic accuracy of the SDI was compared with that of the RI and PI ratios.
  
  
  RESULTS
  Selected groups were statistically comparable in all routinely determined transplant parameters. The SDI was significantly different between patients with normal graft function, acute cellular rejection, and acute vascular rejection (P < .01, analysis of variance on ranks), whereas the RI and PI ratios were only significantly different between patients with normal graft function and acute vascular rejection (P < .05, analysis of variance on ranks). The indices' ranges were defined by the 95% confidence intervals between the allograft functions.
  
  
  CONCLUSIONS
  The developed SDI was able to detect acute renal transplant rejection with greater sensitivity and specificity than the RI and PI ratios. Since the SDI distinguishes between acute tubular necrosis, acute cellular rejection, and acute vascular rejection, it might be a supportive tool to indicate renal biopsy.
authors.affiliation: Department of Internal Medicine I, Transplant Center, University of Lübeck, Lübeck, Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: Meier
authors.affiliation: Department of Internal Medicine I, Transplant Center, University of Lübeck, Lübeck, Germany.|Nephrology Center of Reinbek and Geesthacht, Reinbek, Germany.
authors.forename: Lutz
authors.initials: L
authors.lastname: Fricke
authors.affiliation: Department of Internal Medicine I, Transplant Center, University of Lübeck, Lübeck, Germany.
authors.forename: Katrin
authors.initials: K
authors.lastname: Eikenbusch
authors.affiliation: Department of Internal Medicine I, Transplant Center, University of Lübeck, Lübeck, Germany.
authors.forename: Emma
authors.initials: E
authors.lastname: Smith
authors.affiliation: Department of Internal Medicine I, Transplant Center, University of Lübeck, Lübeck, Germany.|LADR Zentrallabor Dr Kramer & Kollegen, Geesthacht, Germany.
authors.forename: Jan
authors.initials: J
authors.lastname: Kramer
authors.affiliation: Department of Internal Medicine I, Transplant Center, University of Lübeck, Lübeck, Germany.
authors.forename: Hendrik
authors.initials: H
authors.lastname: Lehnert
authors.affiliation: Department of Internal Medicine I, Transplant Center, University of Lübeck, Lübeck, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Nitschke
mesh_terms: D000208:Acute Disease; D003937:Diagnosis, Differential; D005260:Female; D006084:Graft Rejection / Q000000981:diagnostic imaging*; D006801:Humans; D007668:Kidney / Q000000981:diagnostic imaging; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D055031:Primary Graft Dysfunction / Q000000981:diagnostic imaging*; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D018616:Ultrasonography, Doppler, Duplex / Q000379:methods*
keywords: allograft rejection; general and abdominal ultrasound; renal transplant; resistive index; transplant imaging; transplant sonography