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.jpg): Failed to open stream: No such file or directory in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 117 PLoS+One
2016 ; 11
(3
): e0150384
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The Natural History of Kidney Graft Cortical Microcirculation Determined by
Real-Time Contrast-Enhanced Sonography (RT-CES)
#MMPMID26949940
Jiménez C
; López MO
; Ros A
; Aguilar A
; Menendez D
; Rivas B
; Santana MJ
; Vaca MA
; Escuin F
; Madero R
; Selgas R
PLoS One
2016[]; 11
(3
): e0150384
PMID26949940
show ga
BACKGROUND: Kidney transplantation is the therapy of choice for end-stage kidney
disease. Graft's life span is shorter than expected due in part to the delayed
diagnosis of various complications, specifically those related to silent
progression. It is recognized that serum creatinine levels and proteinuria are
poor markers of mild kidney lesions, which results in delayed clinical
information. There are many investigation looking for early markers of graft
damage. Decreasing kidney graft cortical microcirculation has been related to
poor prognosis in kidney transplantation. Cortical capillary blood flow (CCBF)
can be measured by real-time contrast-enhanced sonography (RT-CES). Our aim was
to describe the natural history of CCBF over time under diverse conditions of
kidney transplantation, to explore the influence of donor conditions and
recipient events, and to determine the capacity of CCBF for predicting renal
function in medium term. PATIENTS AND METHODS: RT-CES was performed in 79
consecutive kidney transplant recipients during the first year under regular
clinical practice. Cortical capillary blood flow was measured. Clinical variables
were analyzed. The influence of CCBF has been determined by univariate and
multivariate analysis using mixed regression models based on sequential
measurements for each patient over time. We used a first-order autoregression
model as the structure of the covariation between measures. The post-hoc
comparisons were considered using the Bonferroni correction. RESULTS: The CCBF
values varied significantly over the study periods and were significantly lower
at 48 h and day 7. Brain-death donor age and CCBF levels showed an inverse
relationship (r: -0.62, p<0.001). Living donors showed higher mean CCBF levels
than brain-death donors at each point in the study. These significant differences
persisted at month 12 (54.5 ± 28.2 vs 33.7 ± 30 dB/sec, living vs brain-death
donor, respectively, p = 0.004) despite similar serum creatinine levels (1.5 ±
0.3 and 1.5 ± 0.5 mg/dL). A sole rejection episode was associated with lower
overall CCBF values over the first year. CCBF defined better than level of serum
creatinine the graft function status at medium-term. CONCLUSION: RT-CES is a
non-invasive tool that can quantify and iteratively estimate cortical
microcirculation. We have described the natural history of cortical capillary
blood flow under regular clinical conditions.