Contrast-enhanced ultrasonography for identifying acute kidney injury in brain-dead donors

Abstract

Background Acute kidney injury (AKI) is frequently found in deceased donors; however, few studies have reported the use of imaging to detect and identify this phenomenon. The purpose of this study was to detect renal microcirculatory perfusion in brain-dead donors using contrast-enhanced ultrasonography (CEUS), investigate the value of CEUS in identifying AKI, and analyze the correlation between CEUS and preimplantation biopsy results and early post-transplant renal function of grafts. Methods This prospective study recruited 94 kidneys from brain-dead donors (AKI =44, non-AKI =50) from August 2020 to November 2022. The inclusion criteria were age ≥18 years and brain death. The exclusion criteria encompassed donors maintained with extracorporeal membrane oxygenation (ECMO) and the presence of irregular kidney anatomy. The mean age of the donors was 45.1±10.4 [standard deviation (SD)] years, and the majority were male (86.2%). CEUS was performed prior to organ procurement, and time-intensity curves (TICs) were constructed. The time to peak (TTP) and peak intensity (PI) of kidney segmental artery (KA), kidney cortex (KC), and kidney medulla (KM) were calculated using TIC analysis. Results Arrival time (AT) of KA (P<0.001) and TTP of kidney cortex (TTPKC) (P<0.001) of the non-AKI group were significantly shorter than those of the AKI group. The PI of the KA (P=0.003), KM (P=0.005), and kidney cortex (PIKC; P<0.001) of the non-AKI group were significantly higher than those of the AKI group. Multivariable logistic regression analysis showed that serum creatinine [odds ratio (OR) =1.06; 95% CI: 1.03–1.1; P<0.001], TTPKC (OR =1.38; 95% CI: 1.03–1.84; P=0.03), and PIKC (OR =0.95; 95% CI: 0.91–1; P=0.046) were the independent factors of AKI. The area under the receiver operating characteristic curve (AUC) for identifying AKI for TTPKC and PIKC was 0.73 and 0.71, respectively. TTPKC showed a weak correlation with interstitial fibrosis (r=0.23; P=0.03), PIKC showed a weak correlation with arterial intimal fibrosis ((r=−0.29; P=0.004) and arteriolar hyalinosis (r=−0.27; P=0.008), and PIKC showed the strongest correlation with eGFR on postoperative day 7 (r=−0.46; P=0.046) in the donor kidneys with AKI. Conclusions CEUS can be used to identify AKI in brain-dead donors. Furthermore, there is a correlation between CEUS-derived parameters and pretransplant biopsy results and early preimplantation renal function of grafts.

Evaluation of the efficacy of rat renal ischemia-reperfusion injury after itaconic acid and its isomers treatment by contrast-enhanced ultrasound(CEUS)

“…In addition, the time-intensity curve (TIC) and quantitative parameters(i.e. peak intensity (Peak), time to peak (Tp), area under the curve (AUC) and mean transition time (MTT)) were obtained by quantifying the change of timeconcentration of contrast agents in the region of interest (ROI).These are sensitive indicators of renal blood perfusion, which may help to assess renal tissue damage in the early stages of AKI [13][14][15]. It has been proved that CEUS examination combined with TIC curve analysis has high application value in evaluating renal blood perfusion on IRI [16,17].…”