Clinical and prognostic value of TAMX index of interlobar arteries of the middle segment in patients after allograph kidney transplantation in the late postoperative period

• Main Author: V. V. Yakimenko
• Format: Article
• Language: English
• Published: Kazimierz Wielki University 2020-11-01
• Series: Journal of Education, Health and Sport
• Subjects: logistic regression; late graft dysfunction; pulsation index; wald test; doppler ultrasound
• Online Access: https://apcz.umk.pl/czasopisma/index.php/JEHS/article/view/32004

<p><strong>Introduction. </strong>Kidney transplantation has become the best treatment for patients with end-stage of chronic renal failure. The issues of studying the causes and mechanisms of the development of renal transplant dysfunction in the late postoperative period, the search for high-precision minimally invasive methods for early diagnosis of renal transplant dysfunction remain relevant, since this largely determines the further normal functioning of the organ and prognosis for the patient.</p><p><strong>The aim of the study</strong> was to investigate the clinical and prognostic value of the time-averaged peak velocity (TAMX) index of the interlobar arteries of the middle segment in patients after allograft transplantation in the long-term postoperative period.</p><p><strong>Material and research methods.</strong> For the period 2014-2015 ultrasound scan of renal grafts were performed in 26 patients with creatinine levels within the normative values. The average age of recipients in this group was 31.4 ± 1.67 years. Among the recipients there were 15 men (57.7%), 11 women (42.3%). Living related kidney transplantation (LRKT) were performed in 61.54% of patients, in 38.46% – cadaveric kidney transplantation (CKT). In all patients, the plasma creatinine level met the standard value or exceeded them by no more than 25%, fluctuating on average from 94 to 130 μmol / L, averaging 114.5 ± 3.85 μmol / L.</p><p>The second study is based on the results of ultrasound scan of renal transplants in 26 patients with creatinine levels exceeding the standard values for the period 2015-2016. The average age of recipients in this group was 38.99 ± 2.32 (34.35-43.62) years. There were 14 men (53.84%) among the recipients, and 12 women (46.16%). LRKT were performed in 6 patients, in 20 – CKT. In all patients the plasma creatinine level was above normal values, fluctuating on average from 155 to 629 μmol / L, averaging 259.46 ± 35.33 μmol / L. The groups were comparable in terms of the main clinical and demographic parameters.</p><p><strong>Results.</strong> The method for predicting complications by the level of TAMX of the interlobar arteries of the middle segment of the kidneys during Doppler ultrasonography of the renal blood flow (&lt;15 cm / s) has a fairly high sensitivity (83.87%), specificity (79.31%), positive and negative predictive significance (81.25% and 82.14%, respectively) in the diagnosis of a high risk of developing late nephrodysfunction in recipients after organ transplantation. Recipients with allograft with a TAMX level of interlobar arteries (middle segment) of more than15 cm / s, as a result of our examination, had a serum creatinine level 2.35 times less, and the glomerular filtration rate is almost 2 times higher than similar indicators in patients with a TAMX level less15 cm / s (p &lt;0.01), which confirms the presence of more expressive manifestations of chronic allograft dysfunction.</p><p>The interdependence between the TAMX of the interlobar arteries of the middle segment and serum creatinine, which is gradually regressing in a parabola, shows that more than half of the entire variance of the creatininemia sign can be associated with a change in the TAMX indicator (as a sign of deterioration in the renal blood flow of the graft), and the largest "failure" of the function were observed in the range from 12 to15 cm/ s TAMX, where in the overwhelming majority of cases (about 80%) there were impaired renal hemodynamics and the available laboratory markers of impaired renal function (creatinine above 200 μmol / l).</p><p><strong>Conclusions.</strong> A reliable prognostic value of TAMX of interlobar arteries (middle segment) was shown in spectral Doppler ultrasonography of renal blood flow in a priori assessment of the risk of developing post-transplant nephropathy, which allows us to consider it as a cumulative predictor of an unfavorable prognosis and a potential factor not only for the formation of graft dysfunction, but also for rejection in the late postoperative period.</p>