Radionuclide Procedures in Predicting Early Renal Transplant Rejection

Hayes, Michael; Moore, Thomas C.; Taplin, George V.

doi:10.1148/103.3.627

Cited by 13 publications

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“…quantitated sequential renal scintiphotos [5]. Of these methods the bladder/kidney ratio derived from quantitated scintiphotos was found to be the single most useful indicator of transplant function, and the most sensitive and reliable predictor of rejection [6]. This paper summarizes 5 years of experience and presents a practical protocol for radionuclide evaluation of transplant status, emphasizing the prediction of acute rejection and avoidance of certain pitfalls associated with the recommended.…”

Section: Disclaimermentioning

confidence: 99%

Radionuclide evaluation of renal transplant status

Hayes¹,

Moore²,

Taplin³

1973

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Previous studies hav€ compared the usefulness of this data as well as blood and urine histamine levels with radionuclide studies such as the renogram, the hippurate clearance index, the radionuclide angiogram and quantitated sequential renal scintiphotos [5]. Of these methods the bladder/kidney ratio derived from quantitated scintiphotos was found to be the single most useful indicator of transplant function, and the most sensitive and reliable predictor of rejection [6]. This paper summarizes 5 years of experience and presents a practical protocol for radionuclide evaluation of transplant status, emphasizing the prediction of acute rejection and avoidance of certain pitfalls associated with the recommended.procedures. METHODRadionuclide studies were performed on a frequent basis on human renal homotransplant recipients for at least two weeks postoperatively. Serial scintiphotos were obtained with a Picker Dynacamera 2 with the patient in a supine position following 131 bolus intravenous administration of 300 4Ci of I-hippurate.Renogram and cystogram curves were then generated from magnetic tape recorded data. Simultaneously the blood disappearance rate RESULTS AND DISCUSSIONDuring a five year period 58b examinations were performed on 72 post-renal homotransplant recipients during the first 14 postoperative days. Results were analyzed as described under Method.In approximately 1/3 of these patients a clinically recognized rejection crisis, ranging from mild to severe, occurred during this period of time.The calculation of renogram indices was discontinued about half way through the study as being significantly less sensitive and less reliable than the remaining parameters to be discussed.The hippurate blood clearance index, although generally sensitive, was found to show transient paradoxical improvements just preceding rejection crisis about 50 per ceht of the time.. This phenomenon is apparently related to an outpouring of histamine, which may occur in the days prior to clinical rejection [10] and cause an increase in extravascular extravasation of hippurate. This index was found useful and is determined daily regardless of the general level of transplant function.The bladder/kidney ratio, derived from quantitated scinti-.photos at 20 minutes post-injection, not only proved to be the most sensitive indicator of transplant function, but in over 80%of all cases of early rejection there was a significant drop from 1 to 3 days before clinical rejection, as illustrated byIn acute rejection there was usually a temporary increase in the blood clearance index in association with the fall in bladder/kidney ratio. In delayed hyperacute rejection, associated with presensitization , there were simultaneous marked drops in the blood clearance index and the bladder/kidney ratio.In 20% of the cases in which there was no definite clinical evidence of a rejection crisis, there were transient false positive reductions in the bladder/kidney ratio occurring at the I end of'post-transplant diuresis. In most of these cases the...

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Section: Disclaimermentioning

confidence: 99%

Radionuclide evaluation of renal transplant status

Hayes¹,

Moore²,

Taplin³

1973

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“…Staab et al 1969). 3.Ό ελάχιστος χρόνος πού απαιτείται γιά τήν άφιξη τοΟ ραδιοφάρμακου στην ουροδόχο κύστη (Hayes 1973). 4.Ό λόγος της ραδιενέργειας της κύστεως προς τή ραδιενέργεια τοΟ νεφρού 20 λεπτά μετά τή χορήγηση τοο ραδιοφάρμακου (λόγος Β/Κ).…”

Section: σπιυθηρουράφηση κατ'εξακολούθηση (Sequential Seintigraphy)unclassified

“…5. Τό ΰψος τοο μεγίστου τοϋ νεφρογράμματος μέ Hippuran-Ι 131 μέ τή χορηγηθείσα δόση (Hayes 1973). 6.…”

Section: σπιυθηρουράφηση κατ'εξακολούθηση (Sequential Seintigraphy)unclassified

“…'Αντίθετα, άν ò νεφρός δέν αίματώνεται ικανοποιητικά, τότε ή εικόνα είναι συμβατή μέ ύπεροξεϊα απόρριψη τοϋ μοσχεύματος ή είναι αγγειακή απόφραξη. "Η διαφορική διάγνωση μεταξύ ύπεροξείας απορρίψεως καί αρτηρια κής αποφράξεως δέν έχει πρακτικό ενδιαφέρον, διότι καί οί δύο περιπτώσεις άπαιτοϋν άμεση χειρουργική διερεύνηση (Hayes 1973, L. Rosenthall 1974, P.A. Farrer 1977.…”

Section: σπιυθηρουράφηση κατ'εξακολούθηση (Sequential Seintigraphy)unclassified

“…Ό Hayes (1973) κατά τή διάρκεια της μελέτης πού άφορούσε καθημερινές νεφρογραφικές παρατηρήσεις, διαπίστωσε , δτι στις μισές περιπτώσεις εμφανιζόταν μία παροδική παρά δοξη βελτίωση της ERPF ακριβώς πρίν άπό τήν κρίση τής κλι νικής απορρίψεως.Ή αίτια γιά αυτή τήν παροδική παράδοξη αύξηση της καθάρσεως τοϋ Hippuran-Γ 31 άπό τό αίμα δέν εί ναι γνωστή, οί συγγραφείς πιστεύουν όμως, δτι μπορεί νάσχε-τίζεται μέ απελευθέρωση ισταμίνης άπό τό μόσχευμα, όπως α νακοινώθηκε άπό τόν Moore et al (1970) ή οφείλεται, ,κατά τή γνώμη τοϋ γράφοντος, σέ απελευθέρωση αγγειοκινητικών πεπτι δίων άπό την τοπική ενεργοποίηση τοϋ συμπληρώματος. Τέλος, ò Hayes (1973) ισχυρίζεται, δτι ò δείκτης Β/Κ είΤναι ò πιό ευαί σθητος δείκτης της πρώιμης διαγνώσεως της απορρίψεως.…”

Section: βόAndεΐα άαόρριψηunclassified

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