The Intrarenal Vascular Resistance Parameters Measured by Duplex Doppler Ultrasound Shortly After Kidney Transplantation in Patients With Immediate, Slow, and Delayed Graft Function

Chudek, J.; Kolonko, A.; Król, R.; Ziaja, J.; Cierpka, L.; Więcek, A.

doi:10.1016/j.transproceed.2005.12.013

« Previous Next »Transplantation Proceedings
Volume 38, Issue 1 , Pages 42-45, January 2006

The Intrarenal Vascular Resistance Parameters Measured by Duplex Doppler Ultrasound Shortly After Kidney Transplantation in Patients With Immediate, Slow, and Delayed Graft Function

J. Chudek
- Department of Nephrology, Endocrinology and Metabolic Diseases, Silesian Medical University, Katowice, Poland
- Address reprint requests to J. Chudek, Department of Nephrology, Endocrinology and Metabolic Diseases, ul. Francuska 20/24, 40-027 Katowice, Poland
A. Kolonko
- Department of Nephrology, Endocrinology and Metabolic Diseases, Silesian Medical University, Katowice, Poland
R. Król
- Department of General, Vascular and Transplantation Surgery, Silesian Medical University, Katowice, Poland
J. Ziaja
- Department of General, Vascular and Transplantation Surgery, Silesian Medical University, Katowice, Poland
L. Cierpka
- Department of General, Vascular and Transplantation Surgery, Silesian Medical University, Katowice, Poland
A. Więcek
- Department of Nephrology, Endocrinology and Metabolic Diseases, Silesian Medical University, Katowice, Poland

Abstract

Background

Evaluation of pulsatility (PI) and resistive (RI) indexes by duplex Doppler ultrasound shortly after kidney transplantation reflects the exacerbation of interstitial edema. The aim of study was to characterize factors that influence PI and RI in patients with immediate (IGF), slow (SGF), or delayed (DGF) kidney graft function.

Patients and methods

PI and RI were measured in 200 transplanted patients at 2 to 4 days postoperatively. We excluded patients with acute rejection episodes within the first month. IGF, which was defined as serum creatinine <264 μmol/L at 3 days, SGF, which was defined as creatinine >264 μmol/L by day 3 with a maximum of one dialysis, and DGF, which was defined as more than 1 dialysis were observed in 33.3%, 41.5%, and 25.2% of patients, respectively. The examined donor parameters were age, hypotensive episodes, catecholamine infusion, central venous pressure, and glomerular filtration rate. The recipient factors were age, history of hypertension, diabetes mellitus, ischemic heart disease, and stroke. Additionally cold ischemia time (CIT), HLA mismatch, and PRA were analyzed.

Results

The lowest PI and RI values were observed among patients with IGF (PI 1.37 [1.28 to 1.46]; RI 0.72 [0.69 to 0.74]); moderate values in SGF (PI 1.65 [1.52 to 1.78]; RI 0.78 [0.76 to 0.80]) and the highest values in DGF (PI 2.09 [1.83 to 2.35]; RI 0.83 [0.80 to 0.86]) differences that were highly significant. Hypotensive episodes and catecholamine infusion in the preharvest period had essential impacts on PI or RI values in the early posttransplant period. There was no significant correlation between PI or RI values and CIT. A slower ATN resolution was observed in DGF patients with higher PI values.

Conclusion

Ischemic injury, which occured mainly prior to organ harvesting, played a dominant role determining intrarenal resistance in the early posttransplant period.