Intra-operative and early post-operative cortical resistive indices in renal transplantation: Representative values according to graft function and time of scan

L. Thebridge , C. Fisher , V. Puttaswamy , C. Pollock , J. Clarke
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Abstract

Background

Intra-operative ultrasound during renal transplantation identifies technical abnormalities allowing immediate surgical correction as required. Cortical resistive indices (RIs) assess graft perfusion and are now measured intra-operatively. The aim of this study was to evaluate RIs intra-operatively, and to 30 days post-operatively.

Methods

RIs in consecutive single renal grafts in adults were analysed from 246 grafts scanned intra-operatively, on day 1 post-operatively and subsequently according to physician preference, and 125 grafts scanned intra-operatively to day 30 post-operatively according to a formal protocol.

Results

There was delayed graft function (DGF) in 125 grafts. The mean (±sem) intra-operative RI of 0.599 (±0.009) was significantly lower (p < 0.001) than post-operatively, with the highest RIs on days 3 and 7. RIs on day 30 were similar to day 1. RIs in grafts with function were significantly lower than grafts still requiring dialysis. Mean (±sem) cortical RIs on post-operative days 1, 3, 7 and 30 in functioning grafts were 0.662(±0.005), 0.712(±0.008), 0.703(±0.007) and 0.689 (±0.006) respectively, and in grafts still requiring dialysis 0.721(±0.010), 0.780(±0.010), 0.793(±0.011) and 0.751 (±0.034). The intra-operative RI predicted DGF (AUROC 0.774) as effectively as donor status (live/deceased) (AUROC 0.767). For deceased donor grafts, intra-operative RI was a more effective predictor (AUROC 0.710) than type of donor (DCD/DBD) (AUROC 0.610).

Conclusions

Intra-operative RIs are significantly lower than post-operatively and are indicative of post-operative graft function. Post-operative RIs in non-functioning grafts are consistently higher than in functioning grafts. Observed RIs differ according to the post-operative day of scan, which therefore should also be reported.
肾移植术中及术后早期皮质阻力指数:根据移植物功能和扫描时间的代表性值
背景:肾移植术中超声可识别技术异常,必要时可立即进行手术纠正。皮质阻力指数(RIs)评估移植物灌注,现在在术中测量。本研究的目的是评估术中及术后30天的RIs。方法分析246例成人连续单肾移植在术中、术后第1天及随后根据医生偏好扫描的肾移植,以及125例按照正式方案在术中至术后第30天扫描的肾移植的ris。结果125例移植物存在移植物功能延迟(DGF)。术中平均(±sem) RI为0.599(±0.009),显著低于术后(p < 0.001),其中第3天和第7天的RI最高。第30天的RIs与第1天相似。具有功能的移植物的RIs明显低于仍需要透析的移植物。术后1、3、7、30天,正常移植物皮质RIs均值(±sem)分别为0.662(±0.005)、0.712(±0.008)、0.703(±0.007)、0.689(±0.006),仍需透析的移植物皮质RIs均值为0.721(±0.010)、0.780(±0.010)、0.793(±0.011)、0.751(±0.034)。术中RI预测DGF (AUROC 0.774)与供体状态(AUROC 0.767)一样有效。对于死亡的供体移植物,术中RI是比供体类型(DCD/DBD) (AUROC 0.610)更有效的预测因子(AUROC 0.710)。结论术中RIs明显低于术后,可反映术后移植物功能。无功能移植物的术后RIs始终高于功能移植物。观察到的RIs根据术后扫描日的不同而不同,因此也应报告。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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