PURPOSE: A clinically manifested acute rejection is associated with graft dysfunction and with some ultrasound findings. The aim of our study was to determine the potential of ultrasound evaluation in the detection of subclinical acute rejective changes diagnosed in stable grafts by protocol biopsy. METHODS: Gray-scale evaluation, color Doppler imaging (CDI) and power Doppler imaging (PDI) was performed before each of 184 protocol graft biopsies in 77 patients in the third week, third month and first year after transplantation. The group was divided into four subgroups-normal histological finding, borderline changes, subclinical acute rejection of IA grade, and a clinically manifested acute rejection of IA grade. The sonographic findings were compared with individual groups. RESULTS: Detection of parenchymal edema using gray-scale imaging significantly differentiated borderline changes and subclinical acute rejection of IA grade from normal histological findings in the third week and in the third month (P=0.013, P=0.002 and P=0.024, P<0.001), respectively. A similar finding could be recorded in the latter group in the first year after transplantation (P=0.024). The presence of edema and reduced peripheral parenchymal perfusion in PDI significantly more often indicated a clinically manifested acute IA rejection (P=0.019, P=0.004, P=0.044). Parenchymal CDI hyperperfusion had a high specificity (89.5%) but a low sensitivity (60%) in the detection of the subclinical form of acute IA rejection. CONCLUSION: A composite gray-scale, PDI and CDI evaluation provide a significant differentiation of groups with borderline changes and subclinical acute rejection and groups with normal histological finding and clinically manifested acute rejection.

3rd Department of Internal Medicine and Nephrology Faculty Hospital Olomouc 1 P Pavlova 6 775 20 Olomouc Czech Republic

000      

03411naa 2200457 a 4500

001      

bmc11023015

003      

CZ-PrNML

005      

20130425204257.0

008      

110801s2009 ie e Eng||

009      

AR

040    __

$a ABA008 $b cze $c ABA008 $d ABA008 $e AACR2

041    0_

$a eng

044    __

$a ie

100    1_

$a Krejčí, Karel $7 xx0046900

245    10

$a Sonographic findings in borderline changes and subclinical acute renal allograft rejection / $c K. Krejčí, J. Zadražil, T. Tichý, S Al-Jabry, V. Horčička, P. Štrebl, P. Bachleda

314    __

$a 3rd Department of Internal Medicine and Nephrology, Faculty Hospital Olomouc, I.P. Pavlova 6, 775 20 Olomouc, Czech Republic. karel.krejci@fnol.cz

520    9_

$a PURPOSE: A clinically manifested acute rejection is associated with graft dysfunction and with some ultrasound findings. The aim of our study was to determine the potential of ultrasound evaluation in the detection of subclinical acute rejective changes diagnosed in stable grafts by protocol biopsy. METHODS: Gray-scale evaluation, color Doppler imaging (CDI) and power Doppler imaging (PDI) was performed before each of 184 protocol graft biopsies in 77 patients in the third week, third month and first year after transplantation. The group was divided into four subgroups-normal histological finding, borderline changes, subclinical acute rejection of IA grade, and a clinically manifested acute rejection of IA grade. The sonographic findings were compared with individual groups. RESULTS: Detection of parenchymal edema using gray-scale imaging significantly differentiated borderline changes and subclinical acute rejection of IA grade from normal histological findings in the third week and in the third month (P=0.013, P=0.002 and P=0.024, P<0.001), respectively. A similar finding could be recorded in the latter group in the first year after transplantation (P=0.024). The presence of edema and reduced peripheral parenchymal perfusion in PDI significantly more often indicated a clinically manifested acute IA rejection (P=0.019, P=0.004, P=0.044). Parenchymal CDI hyperperfusion had a high specificity (89.5%) but a low sensitivity (60%) in the detection of the subclinical form of acute IA rejection. CONCLUSION: A composite gray-scale, PDI and CDI evaluation provide a significant differentiation of groups with borderline changes and subclinical acute rejection and groups with normal histological finding and clinically manifested acute rejection.

590    __

$a bohemika - dle Pubmed

650    _2

$a akutní nemoc $7 D000208

650    _2

$a mladiství $7 D000293

650    _2

$a dospělí $7 D000328

650    _2

$a senioři $7 D000368

650    _2

$a ženské pohlaví $7 D005260

650    _2

$a rejekce štěpu $x etiologie $x ultrasonografie $7 D006084

650    _2

$a lidé $7 D006801

650    _2

$a transplantace ledvin $x škodlivé účinky $x ultrasonografie $7 D016030

650    _2

$a mužské pohlaví $7 D008297

650    _2

$a lidé středního věku $7 D008875

650    _2

$a terapie neúspěšná $7 D017211

650    _2

$a ultrasonografie dopplerovská $x metody $7 D018608

650    _2

$a mladý dospělý $7 D055815

700    1_

$a Zadražil, Josef, $d 1954- $7 xx0074493

700    1_

$a Tichý, Tomáš, $d 1960- $7 nlk20030127454

700    1_

$a Al-Jabry, Sadek $7 xx0073836

700    1_

$a Horčička, Vladko, $d 1938-2018 $7 skuk0000602

700    1_

$a Štrebl, Pavel $7 xx0127235

700    1_

$a Bachleda, Petr, $d 1954- $7 jn20020716344

773    0_

$t European Journal of Radiology $w MED00009640 $g Roč. 71, č. 2 (2009), s. 288-295 $x 0720-048X

910    __

$a ABA008 $b x $y 2

990    __

$a 20110802100308 $b ABA008

991    __

$a 20130425204548 $b ABA008

999    __

$a ok $b bmc $g 881867 $s 732944

BAS    __

$a 3

BMC    __

$a 2009 $b 71 $c 2 $d 288-295 $m European journal of radiology $n Eur J Radiol $i 0720-048X $x MED00009640

LZP    __

$a 2011-4B09/jvme