Correlation of histopathologic and dynamic tissue perfusion measurement findings in transplanted kidneys

Abstract

BackgroundCortical perfusion of the renal transplant can be non-invasively assessed by color Doppler ultrasonography. We performed the Dynamic Tissue Perfusion Measurement (DTPM) of the transplant’s renal cortex using color Doppler ultrasonography (PixelFlux technique), and compared the results with the histopathological findings of transplant biopsies.MethodsNinety-six DTPM studies of the renal transplant’s cortex followed by transplant biopsies were performed in 78 patients. The cortical perfusion data were compared with the parameter of peritubular inflammatory cell accumulation (PTC 0 to 3) based on Banff-classification system.ResultsA significant decrease of cortical perfusion could be demonstrated as the inflammatory cells accumulation in peritubular capillaries increased. Increasing peritubulitis caused a perfusion loss from central to distal layers of 79% in PTC 0, of 85% in PTC 1, of 94% in PTC 2, and of 94% in PTC 3. Furthermore, the perfusion loss due to peritubular inflammation was more prominent in the distal cortical layer. The extent of perfusion decline with increasing peritubulitis (from PTC 0 to PTC 3) was 64% in proximal 20% cortical layer (p20), 63% in proximal 50% cortical layer (p50), increased to 76% in distal 50% cortical layer (d50), and peaked at 90% in the distal 20% cortical layer (d20). For those without peritubulitis (PTC 0), the increase in the the Interstitial Fibrosis/Tubular Atrophy (IF/TA) score was accompanied by a significantly increased cortical perfusion. A Polyomavirus infection was associated with an increased cortical perfusion.ConclusionsOur study demonstrated that the perfusion of the renal transplant is associated with certain pathological changes within the graft. DTPM showed a significant reduction of cortical perfusion in the transplant renal cortex related to peritubular capillary inflammation.

Prognostic Value of Dynamic Tissue Perfusion Measurements in Transplanted Kidneys

“…Similar early effects on the renal microvasculature could be demonstrated in a previous study in renal transplants [1] and diabetic kidneys before the onset of microalbuminuria [own paper accepted for publication].…”

“…Whereas DTPM characterize intrarenal factors, in transplanted as well as in native kidneys [10,11]. RI also demonstrated less sensitivity compared to DTPM in transplants with increasing peritubular inflammation [1].…”

Umbilical vein vasomotion detectedin vivoby serial three-dimensional pixelwise spatially angle-corrected volume flow measurements

“…The pixelwise evaluation of blood flow in a variety of tissues and organs, in man and animals, has demonstrated highly significant correlation to relevant physiological (oxygenation) and pathophysiological (histological changes in rejection, fibrosis and inflammation as well as diabetic changes of microperfusion) parameters, and perfusion changes in the female genital tract. 3D fetal perfusion volume measurements have the potential to describe fetal perfusion very precisely.…”

Color Doppler Sonographic Dynamic Tissue Perfusion Measurement Demonstrates Significantly Reduced Cortical Perfusion in Children with Diabetes Mellitus Type 1 without Microalbuminuria and Apparently Healthy Kidneys

“…No traditional Doppler technique takes both parameters into account. Here lies the advantage of DTPM which has been proven to be superior to RI to describe histological changes in renal transplants [23]. DTPM also reflects renal cortical fibrosis and can describe tissue oxygenation [24].…”