Ultrasound elastography (USE) is a method to assess the stiffness of parenchymatous organs. Shear wave elastography (SWE) is considered to be the most suitable elastography method for the non-invasive kidney transplant (KTx) elasticity assessment. The aim of this study was to assess the implementability of SWE for the evaluation of kidney transplant elasticity measurement depending on the depth of an allograft, body mass index (BMI) and donor age. Secondly, to investigate the associations between SWE stiffness measurements and the clinical parameters. This cross-sectional prospective study involved consecutive 100 KTx patients were grouped according to time from transplantation and their BMI (in BMI<25 group the mean was 22.1±2.4, n=42 and in BMI≥25 group the mean BMI was 29.9±3.3, n=58). Mean estimated glomerular filtration rate was almost similar in both groups: <25 group 54.3 and ≥25 group 53.4 mL/min. Mean elastography results were found statistically different (p=0.006) BMI<25 (8.95±5.84 kPa) and BMI≥25 (5.95±3.16 kPa) groups. Significant correlation was found between SWE and the depth of the measurement (r=−0.4, p<0.05). The variations in USE stiffness values were smallest in patients group with lower BMI. In conclusion, we demonstrated that the non-invasive USE measurement stiffness result depends on a patient’s BMI, the depth of renal allograft and donor age.
viremia earlier. He received pulse with methylprednisolone and Advagraf was increased. Immediately before this admission, his creatinine was stable around 140 150 umol/L and was maintained on Advagraf 5 mg OD, Myfortic 720 mg BD and Prednisolone 5 mg OD. His tacrolimus level was around 3-4 ug/L.His creatinine was rising to 170 umol/L in August 2020, and his biopsy revealed severe tubulitis, tubular vacuolation, viral inclusions with positive for SV40. His Luminex SAB showed no HLA-DSA. His BKV PCR was 11,100 copies/mL. His anti-metabolite was ceased. Unfortunately, his creatinine was increasing two weeks later to 220 umol/ L. He was scheduled for first IVIG, tacrolimus was stopped, and prednisolone was pushed up to 10 mg daily. Repeated BKV PCR was 80,100 copies/mL on the 24 th September 2020 and further reduced to 750 copies/mL and 150 copies/mL after completed two rounds of IVIG 2 gm/kg/cycle. At present he is only on prednisolone 10 mg OD and just received his 3 rd round of IVIG. His creatinine latest static around 210 umol/L with no active urinary sediments. Interestingly his lymphocytes subsets were depleted upon this presentation and subsequent monitoring as showed in table 1.Table 1: Serial lymphocytes subset before withholding the immunosuppression and while on IVIG Conclusions: IVIG with aggressive reduction of immunosuppression is a crucial management in this case to treat the BKVN. Even though his creatinine is not back to the baseline, but it has remained stable with marked reduction of BKV PCR. The immune reconstitution after withdrawing immunosuppression is nicely illustrated with increasing CD4+, CD8+ and B cells.
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