Non Invasive Monitoring Of Early Stage Renal Function In Kidney Transplant Recipients

Background: Dynamic monitoring of renal allograft function has become a focus to modern clinical kidney transplantation.Today,serum creatinine is the most commonly used indicator to evaluate and predict renal function of transplanted kidneys,It has a certain diagnostic value.Renal biopsy is the gold standard used to evaluate the function of the renal graft,but it is invasive.At present,there are some discovered indictors less invasive,which are used for early detection and early intervention of common post surgery complications.The purpose of this study is through the detection of pre transplant peripheral blood T lymphocyte subsets(CD3+,CD4+,CD8+,CD4+/CD8+)and early postoperative Doppler ultrasound,analysis of the relationship and significance between these indicators and early postoperative renal graft function restoration,in order to provide reference for preventive treatment after kidney transplantation.Methods: The kidney transplant recipients in Ruijin Hospital Affiliated to Shanghai Jiao tong University School of Medicine from January 2014 to December2016 were selected as the research object,and divided into two parts:The first part: collect the data of uremia patients who underwent kidney transplantation in our hospital during this period,flow cytometry was used to detect the CD3+,CD4+,CD8+ and the corresponding absolute count of T lymphocyte subsets;in regard to the estimated glomerular filtration rate(eGFR)of 3 months after renal transplantation,the patients were divided into low and high group eGFR,The relationship between CD3+T lymphocyte,CD4+/CD8+,CD4+T lymphocyte,CD8+T lymphocyte and its absolute count and eGFR 3 months after operation were compared.The second part: from January 2014 to June 2016 due to chronic renal failureuremia underwent allograft renal transplantation in kidney transplantation center of Ruijin Hospital Affiliated to Shanghai Jiao tong University School of Medicine after regular follow-up in outpatient,Within a month after transplantation an ultrasonography is done,calculate the inter lobar and arcuate artery's RI(vascular resistance index)and peak systolic velocity(PSV),evaluate the relationship between eGFR and RI,PSV,early proteinuria and renal function at 6 months after transplantation.Results: The first part had a total of 38 cases,21 male cases and 17 female cases;with an average age of 40.42±12.97,cadaveric kidney transplantation in 24 cases,and living related kidney transplantation in 14 cases,CD3+T lymphocyte count in low group eGFR before transplantation was significantly higher than that in high eGFR group:75.59±6.63 vs.68.82±8.01(P=O.007)CD4+T lymphocyte count in eGFR low group before transplantation was significantly higher than that in eGFR high group: 47.05±5.77 vs.39.83±7.77(P=O.003);CD4+T cell absolute count in eGFR low group before transplantation was significantly higher than that in eGFR high group:691.68±293.03 vs.507.74±256.02±7.77(P=O.047).Univariante analysis showed that CD3+T lymphocyte count and CD4+T lymphocyte count was significantly negatively correlated with the eGFR value at 3 months after transplantation.Moreover,Logistic regression analysis showed that CD3+T cell and CD4+Tcell were negatively associated with eGFR level of 3month post transplant(all p value<0.05).The second part had a total of 42 cases,30 male cases and 12 female cases;with an average age of 38.19±10.23,cadaveric kidney transplantation in 26 cases,and living related kidney transplantation in 16 cases.There was a negative correlation between the RI of the transplanted renal inter lobar,arcuate artery in the first month and eGFR at 6 months after the transplantation.There was no correlation between PSV and eGFR 6 months after surgery.We found that there is correlation between RI,early post operative proteinuria and eGFR 6 months after surgery.Conclusion: eGFR in kidney transplant recipients with high number of CD3+ andCD4+T T lymphocyte subsets count tend to maintain a low level of eGFR at 3 months after transplantation.Therefore,the status of immune function in renal transplant recipients prior to surgery may affect the prognosis of renal graft.Early Doppler ultrasound measurement of the resistance index of the transplanted renal Interlobular and arcuate artery can predict the postoperative 6-months outcome of renal transplantation recipients without distinct complications.