Renal vascular resistance is increased in patients with kidney transplant

Abstract

Background

Despite improvement in short-term outcome of kidney transplants, the long-term survival of kidney transplants has not changed over past decades. Kidney biopsy is the gold standard of transplant pathology but it’s invasive. Quantification of transplant blood flow could provide a novel non-invasive method to evaluate transplant pathology. The aim of this retrospective cross-sectional pilot study was to evaluate positron emission tomography (PET) as a method to measure kidney transplant perfusion and find out if there is correlation between transplant perfusion and histopathology.

Methods

Renal cortical perfusion of 19 kidney transplantation patients [average time from transplantation 33 (17–54) months; eGFR 55 (47–69) ml/min] and 10 healthy controls were studied by [¹⁵ O]H₂O PET. Perfusion and Doppler resistance index (RI) of transplants were compared with histology of one-year protocol transplant biopsy.

Results

Renal cortical perfusion of healthy control subjects and transplant patients were 2.7 (2.4–4.0) ml min^− 1 g^− 1 and 2.2 (2.0–3.0) ml min^− 1 g^− 1, respectively (p = 0.1). Renal vascular resistance (RVR) of the patients was 47.0 (36.7–51.4) mmHg mL^− 1min^− 1g^− 1 and that of the healthy 32.4 (24.6–39.6) mmHg mL^− 1min⁻¹g⁻¹ (p = 0.01). There was a statistically significant correlation between Doppler RI and perfusion of transplants (r = − 0.51, p = 0.026). Transplant Doppler RI of the group of mild fibrotic changes [0.73 (0.70–0.76)] and the group of no fibrotic changes [0.66 (0.61–0.72)] differed statistically significantly (p = 0.03). No statistically significant correlation was found between cortical perfusion and fibrosis of transplants (p = 0.56).

Conclusions

[¹⁵ O]H₂O PET showed its capability as a method in measuring perfusion of kidney transplants. RVR of transplant patients with stage 2–3 chronic kidney disease was higher than that of the healthy, although kidney perfusion values didn’t differ between the groups. Doppler based RI correlated with perfusion and fibrosis of transplants.