Introduction:
Renal transplantation offers better outcomes in terms of quality of life and mortality compared to dialysis for patients with end-stage renal disease (ESRD). However, concerns persist regarding graft dysfunction and premature graft loss in transplant recipients. Doppler ultrasonography, specifically measuring the resistive index (RI), shows promise as a non-invasive tool for assessing renal allografts and predicting graft dysfunction early. This study aims to investigate the role of Doppler RI in the early post-operative period in predicting early graft function, focusing on its correlation with serum creatinine.
Methods:
Conducted as a prospective cohort study, the research was done in the transplant unit of the nephrology department of our hospital over a 15 months of study period. 146 renal allograft recipients meeting inclusion criteria was monitored with Doppler ultrasonography and RI measurement was done on post-operative day 6 or 7. Serum creatinine and proteinuria was monitored for three months post-transplantation. Correlation between RI values and creatinine values at various intervals studied using statistical methods. The study group was divided into two groups ,RI > 0.65 and RI < 0.65 and followed up for graft dysfunction at 3 months [defined by rise in serum creatinine and/or proteinuria defined by standard protocol . The study aims to determine the pattern of RI in the early postoperative period, correlate it with graft function measured by serum creatinine, and assess its predictive value for graft outcomes.
Results:
Among 146 renal allograft recipients meeting the inclusion criteria, mean age was 43 yrs (SD +/- 10.6 yrs) and 74% were males and 26% were females ; 97% were from live related donors, and 3% from live unrelated donors. Among the transplants 95% were first transplants, and 5% were second transplants. Haemodialysis duration varied from <6 months to >3 years. IgA nephropathy was most common (27.4%) native kidney disease followed by diabetic nephropathy (13%).Among the recipients 93.8% had a negative CDC crossmatch. Mean hemoglobin was 10.2 g/dl, and mean serum albumin was 3.2 g/dl among the study group.The induction agent used was Antithymoglobulin - ATG (48%) or Grafalon (43%). Mean RI value was 0.67 with SD 0.098 and serum creatinine levels varied across post-operative days. Immediate graft dysfunction was noted among 25% of recipients of which 87% were mild and recovered completely.Among immediate post transplant infections UTI, LRTI, and SSI were diagnosed in 5.4%, 4.1%, and 3.4% respectively. Patients’ age, weight, haemoglobin and serum albumin had no significant association with RI values. Significant association was found between high RI values and early graft dysfunction. Significant positive correlation was found between RI and creatinine on day 7 (p = .002), RI and creatinine on day 14 (p = .026). , RI and creatinine on day 30 (p = .047),RI and creatinine on day 60 (p < .001).Strong significant positive correlation found between RI and creatinine on day 90 (p < .001). Significant association was found between RI > 0.65 and early graft dysfunction at 3 months post renal transplantation (p < 0.05).
Conclusions:
The study depicts that there exists a significant positive correlation between renal artery resistive index (RI) measured in the early post-transplant period and serum creatinine levels at various post-operative time points, indicating RI's potential utility as an indicator of early graft function post-transplantation. Moreover, the association between RI exceeding 0.65 and early graft dysfunction at 3 months post-transplantation underscores the predictive value of RI in assessing graft outcomes. These findings collectively highlight the significance of RI monitoring in post-transplant care for predicting graft outcomes and guiding clinical interventions.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.