Shear Wave Elastography in Evaluating Acute Kidney Allograft Dysfunction: Preliminary Results.

Main Article Content

Carmen García Roch Fernando García García María Esther Gordo Flores Ruben Giovanetti González Miguel Ángel Muñoz Cepeda Maria Luisa Rodríguez Blanco Manuela Mollejo Villanueva

Abstract

Background


In absence of pharmacological toxicity, allograft dysfunction is usually due to parenchymal inflammation and tubulointerstitial fibrosis, but its clinical signs are often non-specific and tend to appear when advanced damage has been established. We investigated whether Shear Wave Elastography (SWE), a new non-invasive ultrasound (US) based technique that estimates tissue stiffness, could provide early confident diagnosis of acute allograft dysfunction compared to biopsy (gold standard technique).


 


Methods


We designed a single Centre, case-controls, prospective, longitudinal and analytical study that included all kidney transplanted patients with acute allograft dysfunction referred for biopsy at our Institution for 21 months. Within 24 hours after laboratory tests an initial US and Doppler examination was performed. If non-parenchymal, urinary or vascular complications were encountered, the patient was considered as case. We gathered consecutive normal-functioning transplanted patients referred for routine follow-up. If no US abnormalities were encountered, they were classified as controls. 7 quantitative SWE measurements at each allograft´s cortical region were acquired (kilopascals (kPa). Within 24 hours, same-point allograft biopsies were performed by Nephrologists in cases. Once Pathology results were available statistical analysis were subsequently performed.


 


Results

26 patients (13 cases and 13 controls) were enrolled. Creatinine serum mean values were 4,18mEq/dL in cases and 1,84 in controls. SWE mean values were of 21,45 kPa in cases and 13,73 in controls. Biopsies were evaluable in all cases. Statistical analysis showed a positive relation between SWE and creatinine levels. No significance was found of SWE with anatomopathological results in terms of rejection/others, neither with rejection type.


 


Conclusions

SWE is a helpful, non-invasive tool for early diagnosis of kidney allograft dysfunction. Patients with higher elasticity values, in absence of clinical or analytical manifestations, should be included in an increased surveillance program since parenchymal disorders may be incipient. However further studies, with larger cohorts, are necessary to validate these findings.

Keywords: Kidney allograft, Shear Wave Elastography, Ultrasound, Acute allograft dysfunction, Kidney transplant

Article Details

How to Cite
ROCH, Carmen García et al. Shear Wave Elastography in Evaluating Acute Kidney Allograft Dysfunction: Preliminary Results.. Medical Research Archives, [S.l.], v. 9, n. 6, june 2021. ISSN 2375-1924. Available at: <https://esmed.org/MRA/mra/article/view/2462>. Date accessed: 29 mar. 2024. doi: https://doi.org/10.18103/mra.v9i6.2462.
Section
Research Articles

References

1. Kaballo MA, Canney M, O'Kelly P, Williams Y, O'Seaghdha CM, Conlon PJ. A comparative analysis of survival of patients on dialysis and after kidney transplantation. Clin Kidney J. 2018;11(3):389-393.
2. Coemans M, Süsal C, Döhler B, et al. Analyses of the short- and long-term graft survival after kidney transplantation in Europe between 1986 and 2015. Kidney Int. 2018;94(5):964-973.
3. Roslyn B. Mannon. Chapter 63. Post-transplantation monitoring and outcomes. Editor(s): Arthur Greenberg, Alfred K. Cheung, Thomas M. Coffman, Ronald J. Falk, J. Charles Jennette. Primer on Kidney Diseases (Fifth Edition). W.B. Saunders. 2009. Pages 534-542. ISBN 9781416051855.
4. Nankivell BJ, Kuypers DR. Diagnosis and prevention of chronic kidney allograft loss. Lancet. 2011;378(9800):1428-1437.
5. Goldberg RJ, Weng FL, Kandula P. Acute and Chronic Allograft Dysfunction in Kidney Transplant Recipients. Med Clin North Am. 2016;100(3):487-503.
6. Naik RH, Shawar SH. Renal Transplantation Rejection. [Updated 2020 Dec 9]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan. Available from: https://www.ncbi.nlm.nih.gov/books/NBK553074/
7. Alberú-Gómez J, Hernández-Méndez EA, Oropeza-Barrera I, et al. Incidencia de rechazo agudo en pacientes con disfunción del injerto renal [Incidence of acute rejection in patients with renal graft dysfunction]. Rev Invest Clin. 2013;65(5):412-419.
8. Hassanein M, Augustine JJ. Chronic Kidney Transplant Rejection. [Updated 2020 Jul 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from https://www.ncbi.nlm.nih.gov/books/NBK549762/
9. Katsuma, A., Yamakawa, T., Nakada, Y et al. Histopathological findings in transplanted kidneys. Ren Replace Ther. 2017;3:6.
10. Ganji MR, Harririan A. Chronic allograft dysfunction: major contributing factors. Iran J Kidney Dis. 2012;6(2):88-93.
11. Bohl DL, Brennan DC. BK virus nephropathy and kidney transplantation. Clin J Am Soc Nephrol. 2007;2 Suppl 1:S36-S46.
12. https://www.uptodate.com/contents/kidney-transplantation-in-adults-evaluation-and-diagnosis-of-the-patient-with-renal-allograft-dysfunction#H2735963385.
13. Williams WW, Taheri D, Tolkoff-Rubin N, Colvin RB. Clinical role of the renal transplant biopsy. Nat Rev Nephrol. 2012;8(2):110-121.
14. Broecker V, Mengel M. The significance of histological diagnosis in renal allograft biopsies in 2014. Transpl Int. 2015;28(2):136-143.
15. Leong KG, Coombs P, Kanellis J. Renal transplant ultrasound: The nephrologist's perspective. Australas J Ultrasound Med. 2015;18(4):134-142.
16. Expert Panel on Urologic Imaging: Taffel MT, Nikolaidis P, et al. ACR Appropriateness Criteria® Renal Transplant Dysfunction. J Am Coll Radiol. 2017;14(5S):S272-S281.
17. García Roch C, Muñoz Cepeda MÁ, García García F, Ciampi Dopazo JJ, Pinto Varela JM, Díaz Crespo FJ. Contrast Enhanced Ultrasound (CEUS) efficiency in renal graft complications evaluation. Rendimiento de la ecografía con contraste (CEUS) en la valoración de las complicaciones del injerto renal. Nefrologia. 2018;38(4):444-446.
18. Sarvazyan AP, Rudenko OV, Swanson SD, Fowlkes JB, Emelianov SY. Shear wave elasticity imaging: a new ultrasonic technology of medical diagnostics. Ultrasound Med Biol. 1998;24(9):1419-1435.
19. Ferraioli G, Wong VW, Castera L, et al. Liver Ultrasound Elastography: An Update to the World Federation for Ultrasound in Medicine and Biology Guidelines and Recommendations. Ultrasound Med Biol. 2018;44(12):2419-2440.
20. Evans A, Whelehan P, Thomson K, et al. Invasive breast cancer: relationship between shear-wave elastographic findings and histologic prognostic factors. Radiology. 2012;263(3):673-677.
21. Sigrist RMS, Liau J, Kaffas AE, Chammas MC, Willmann JK. Ultrasound Elastography: Review of Techniques and Clinical Applications. Theranostics. 2017;7(5):1303-1329.
22. Leong SS, Wong JHD, Md Shah MN, et al. Shear wave elastography accurately detects chronic changes in renal histopathology. Nephrology (Carlton). 2021;26(1):38-45.
23. Chhajer G, Arunachalam VK, Ramasamy R, Mehta P, Cherian M. Elastography: a surrogate marker of renal allograft fibrosis - quantification by shear-wave technique. Pol J Radiol. 2021;86:e151-e156.
24. Grenier N, Poulain S, Lepreux S, et al. Quantitative elastography of renal transplants using supersonic shear imaging: a pilot study. Eur Radiol. 2012;22(10):2138-2146.