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CZECH MEDICAL ASSOCIATION J. Ev. PURKYNĚ |
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Česky / Czech version | Vnitř. Lék., 48, 2002, No. 10, p. 936 - 942 |
Subclinical Rejection and the Possibilities of its Diagnostic Krejčí K.1, Zadražil J.1, Horčička J. jr.1, Al-Jabri S.1, Dušek J.2, Tichý T.2, Bachleda P.3, Král V.3 1III. interní klinika Lékařské fakulty UP a FN, Olomouc, přednosta prof. MUDr. V. Ščudla, CSc. 2Patologicko-anatomický ústav Lékařské fakulty UP a FN, Olomouc, přednosta prof. MUDr. Z. Kolář, CSc. 3I. chirurgická klinika Lékařské fakulty UP a FN, Olomouc, přednosta prof. MUDr. V. Král, CSc. |
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Summary: Resource: The subclinical rejection is defined as finding of histological signs of rejection on well
functioning grafts. Its diagnostic domain remains protocol biopsy. The diagnostic value of ultrasound
scaning in subclinical rejection has not been studied yet. Aim: The aim of our study was to
detect the incidence of subclinical rejection in protocol biopsies in the first three months after
kidney transplantation and to find out the ultrasound correlation to histological picture of subclinical
rejection with special accent on ultrasound signs of parenchymal oedema, quantity and
quality of perfusion emphasising their changes in process of time. Methods: Sixty six protocol
graft biopsies were performed on 36 recipients of cadaveric renal transplants in Transplant
Centrum Olomouc between July 1999 and September 2000. The biopsies were carried out 21 ± 2
days and 90 ± 5 days after transplantation. Subclinical rejection was defined as t2 i2 v0 (IA)
rejection infiltrate by Banff 97 histological classification at the same time with serum creatinine
in normal range and ultrasound signs of parenchymal oedema. Results: In the group of subclinical
rejection the ultrasound findings of graft parenchymal oedema correlated with 81 % sensitivity
and 90 % specificity with histological diagnosis. The duplex picture of parenchymal hyperaemia -
blush - had 100 % specificity but low sensitivity. The resistive indices were in the wide range 0,61 -
0,80 without diagnostic value. Conclusion: The high sensitivity and specificity of ultrasound prospective
follow up was found in the subclinical rejection diagnosis. Parenchymal hyperaemia
indicated high specificity but low sensitivity in evaluation of subclinical rejection. No benefit of
resistive indices was found. Larger sample of patients has to be established to gain more exact
review anyway.
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