| Objective:The color doppler ultrasound was used to observe the morphology,size,blood vessels,and structured changes of the kidney transplantation.Then the results were analysed in a comprehensive way which provided kindey and graft morphological structure and hemodynamic information of the donors after cardiac death(DCD).This research,based on ultrasonic imaging techniques evaluating the quality of the DCD for the kidneys,provides timely,reliable prognosis and will help clinicians deal with different complications to improve DCD graft survival.Methods:1.67 DCD transplant renal receptors,45 males and 22 females,were collected in Kunming First People's Hospital from June 2012 to December 2016.Their ages were from 19 to 57,with an average of 40.4±9.92 years.The inclusion criteria were DCD transplantation with the consent of the ethics committee and family members.2.Classification standard:According to renal arterial blood flow parameters,serum creatinine,and transplanted kidney volume,65 cases of transplanted kidneys survived were divided into abnormal group 14 cases and normal group 51 casse.Classification standard.(1)Two of the following three items are met as abnormal groups:? RI<0.8 or RI>0.5,? Scr>140(?mol/L),? Volume>140(?mol/L).(2)At the same time,the following three items are met as the normal group:?0.5<RI<0.80,? 40(?mol/L)<Scr<140(?mol/L),? 70(ml)<Volume<160(ml).(3)Among the 14 cases of abnormal group,8 cases were rejected by pathological diagnosis as rejection group.3.The collected cases were examined by using Toshiba Aplio 500,GE LOGIQ,Hitachi a-10,Philips EPIQ5.An abdominal convex array probe was used and its frequency was set at 2-5 MHz.4.A multi-slice scan of the DCD kidney transplantation was performed to observe the right or left iliac fossa,morphology,size,surrounding condition,and internal structure of the transplanted kidney.Two-dimensional ultrasound was used to measure the long diameter,width,anteroposterior diameter and parenchymal thickness of kidneys.Then the kidney volume was calculated according to the following formula:V = L×W×H×?/6(L is the maximum length of kidney longitudinal profile,W is kidney Maximum longitudinal width,H is the maximum anteroposterior diameter of transplanted kidney).The outline,shape of the transplanted kidney and the echo of the renal capsule were observed.The boundary and echo clearness of the cortex and medulla were checked.The renal pelvis and calice were checked for the existence of hydrops,dilatation and hydronephrosis.The vascular anastomosis,iliac vessels and renal artery were checked for the existence of abnormal echo.The perirenal site was checked for the existence of effusion.Ultrasound was used to observe and record the color spectrum distribution at different levels of blood flows in the renal artery,the renal segmental artery,the interlobar renal artery,the arcuate artery and the interlobular artery.The hemodynamic parameters included peak systolic velocity(Vmax),end diastolic velocity(Vmin),resistive index(RI),pulsatility index(PI),acceleration(Acce)and acceleration time(AT).Finally,the case data was used to conduct comparative and statistical analysis.5.Firstly,conventional ultrasound examination of the transplanted kidney is to select the best section of transplanted kidney,and mix the contrast agent Sonovue with(5ml)0.9%normal saline,and then perform the ultrasound examination:1.2ml sound suspensions are injected into venae mediana cubiti or subclavian vein,(which can be increased or decreed by machine as appropriate)with rapid injection of 5ml saline;At the same time,the contrast agent is pushed to analyze the enhancement process in suspected areas of transplanted kidney with real-time observation and records.Angiography can be repeated according to the patient's condition,but the interval of each imaging should be greater than 15min.6.Use SPSS.22.0 software for analysis.(1)The data of 65 cases of survival transplant kidney and normal group and abnormal group were statistically analyzed.The normal distribution data were expressed as mean tstandard deviation,and the abnormal distribution data were expressed by the rank sum test method.(2)Correlation analysis:Use the scatter diagram method to analyze the correlation between renal artery resistance index in all stages of renal allograft and serum creatinine in 65 survivors of transplanted kidney.(3)Differential test:Use independent sample t test for the data of abnormal group and normal group,as well as normal group and rejection group to analyze whether the difference is statistically significant.Results:1.Among the 67 cases,there was 1 case of death and 1 cases of kidney removal after the operations.Post-complications in the 67 cases were:6cases with delayed graft function(9%),8 cases with acute rejection(12%),67 cases with perirenal effusion(100%),13 cases with perirenal hematoma(19.4%),1 case with renal artery stenosis(1.5%),2 cases with ureteral stricture(3%),4 cases wih hydronephrosis(6%),2 cases with pseudoaneurysm(3%),2 cases with infection(3.0%),and 3 cases with urine leakage(4.5%).2.Ultrasonic features:the outline of the transplanted kidney was smooth,the parenchymal thickness was normal,the boundary between the cortex and medulla was clear,the renal parenchyma and the collection system were well-distributed and there was no separation in the collection system.The volume increased or maintained its original size.Renal vascular blood flow signal was rich,clear and reached to the renal cortex.The RI<0.8.The systolic curve rose steeply and fell slowly,and the diastolic curve was flat.RI and PI gradually reduced with the size change of blood vessels.Ultrasonic contrast features:the development sequence of contrast enhanced ultrasound was from renal artery to microvessels and from cortex to medulla.The section of renal parenchyma was like a"fireball".The slope of the TIC curve decreased gradually,while the time of renal perfusion gradually increased with the sequence of the renal artery,cortex,whole kidney and medulla.3.Transplanted renal artery,renal segmental artery and interlobar renal artery were observed in the 65 cases in this study.The time gradient curve of the peak systolic velocity (Vmax),end diastolic velocity(Vmin),pulsatility index(PI),resistive index(RI),acceleration(Acce)and acceleration time(AT)of renal arteries were monitored.There was a huge curve fluctuation in the first week after surgery with an overall upward trend,and in the month after surgery it gradually stabilized and fell back to the "baseline" level.4.In this study,the correlations between RI and renal function in different graded renal arteries were analyzed.The RI of renal function in allograft aortic,renal segmental artery,and interlobar renal artery,showed positive correlations with the renal function.Their correlation coefficients were 0.4497,0.4033,0.3615 respectively,signifying that renal aorta RI and the renal segment artery RI was medium significantly related to renal function-The RI of interlobar renal artery demonstrated weak insignificance in relation to renal function.5.In this study,it was found that recipients with acute rejection had a significant RI increase,a significant renal volume increase,and a significantly higher level of serum creatinine(p<0.05)than the normal transplanted kidney receptors.We also found that a significant RI increase,a significant renal volume increase,and a significantly higher level of serum creatinine(p<0.05)but when compared with patients that had no acute rejection had occurred on its own.Conclusion:Ultrasound examination can not only facilitate fast,non-invasive and real-time dynamic monitoring transplantation kidneys of DCD receptors,but also assessing transplantation renal function by measuring hemodynamics parameters of different levels of transplantation renal arteries.Thus it provids timely and reliable imaging evidence for clinical practice and guidance for the prognosis of kidney transplantation of DCD receptors.Moreover,puncture,drainage and biopsy were performed under ultrasound guidance for diagnosis and treatment.It can also be used for the prevention of postoperative complications and improvement of survival rate of DCD kidney transplantation. |
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