Value of ex vivo sound touch elastography in the assessment of donor kidney fibrosis after brain death
10.3760/cma.j.cn131148-20240507-00268
- VernacularTitle:声触诊弹性成像评价离体脑死亡供肾纤维化的价值
- Author:
Daopeng YANG
1
;
Gang HUANG
;
Fushun PAN
Author Information
1. 中山大学附属第一医院超声器官移植科，广州 510080
- Publication Type:Journal Article
- Keywords:
Elastic imaging technology;
Kidney transplantation;
Elastic value;
Renal fibrosis
- From:
Chinese Journal of Ultrasonography
2024;33(12):1056-1061
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the value of ex vivo sound touch elastography (STE) in evaluating donor kidney fibrosis after brain death. Methods:From March 2022 to August 2023, 94 kidneys donated after brain death in the Organ Transplant Center of the First Affiliated Hospital of Sun Yat-sen University were prospectively included. Baseline gray-scale ultrasound (kidney size, parenchymal thickness, and cortical echo quantification) and ex vivo STE were performed prior to transplantation. The STE indexes included superficial cortex (STE SC), deep cortex (STE DC) and medulla (STE ME). Zero-time biopsy was performed for all the donor kidneys. The donor kidneys were divided into 3 groups based on pathological Remuzzi score as gold standard, including Remuzzi 0-3 group ( n=50), Remuzzi 4-6 group ( n=32) and Remuzzi 7-12 group ( n=12). Analysis of variance or Pearson χ 2 test was used to evaluate the differences between groups for baseline demographic features, gray-scale ultrasound and STE. The intra-group correlation coefficient was used to evaluate the intra-observer repeatability of STE parameters. The correlation between variables was assessed by Spearman rank correlation coefficient, and the value of STE in evaluating renal fibrosis was evaluated by ROC curve. Results:There were significant differences in hypertension and diabetes prevalence among the 3 groups (all P<0.05). There were no significant differences in donor kidney size (kidney length diameter, thickness diameter and parenchymal thickness) among the 3 groups (all P>0.05), whereas the difference of cortical echo was statistically significant among the 3 groups ( P<0.05). There were statistically significant differences in the elasticity values of different regions (STE SC, STE DC and STE ME) among the 3 groups (all P<0.001). Further comparison between the two groups showed that the differences of STE parameters were statistically significant (all P<0.01) apart from the difference of STE ME between the Remuzzi 0-3 group and the Remuzzi 4-6 group. The intraclass correlation coefficients in STE SC, STE DC and STE ME groups were 0.825, 0.908 and 0.908, respectively, the intraobserver repeatability was excellent. Donor age, incidence of diabetes and hypertension, cortical echo, STE SC, STE DC and STE ME were all positively correlated with Remuzzi score ( rs=0.314, 0.273, 0.412, 0.391, 0.654, 0.591 and 0.356, respectively; all P<0.05). For the group diagnosed with Remuzzi 0-3 group, the areas under ROC curve of cortical echo, STE SC, STE DC and STE ME were 0.673 (cut-off value 36.3), 0.840 (cut-off value 15.7 kPa), 0.798 (cut-off value 27.2 kPa) and 0.675 (cut-off value 42.8 kPa), respectively. The diagnostic efficiencies of STE SC and STE DC were higher than that of cortical echo (all P<0.001). For the Remuzzi 7-12 group, the areas under ROC curves of cortical echo, STE SC, STE DC and STE ME were 0.753 (cut-off value 46.5 kPa), 0.905 (cut-off value 20.4 kPa), 0.914 (cut-off value 33.4 kPa) and 0.907 (cut-off value 45.6 kPa), respectively. The diagnostic efficiencies of STE SC, STE DC and STE ME were better than that of cortical echo (all P<0.001). Conclusions:STE can effectively evaluate the degree of fibrosis of donor kidney, and it is feasible to provide imaging evidence for the evaluation of donor kidney after brain death.
