Renal 123I-MIBG Uptake before and after Live-Donor Kidney Transplantation

Abstract

Increased sympathetic activity is suggested to be part of the pathogenesis in several diseases. Methods to evaluate sympathetic activity and renal nervous denervation procedural success are lacking. Scintigraphy using the norepinephrine analog Iodine-123 Metaiodobenzylguanidine (123I-MIBG) might provide information on renal sympathetic nervous activity. Renal transplantation induces complete denervation of the kidney and as such represents an ideal model to evaluate the renal 123I-MIBG scintigraphy method. The aim of this study was to evaluate whether renal 123I-MIBG scintigraphy can detect changes in renal sympathetic nervous activity following renal transplantation. Renal 123I-MIBG scintigraphy was performed in eleven renal transplant recipients at 1, 3, and 6 months following transplantation and in their respective living donors prior to their kidney donation. Relative uptake as well as washout was obtained. In transplanted patients, the relative 4 h uptake of 123I-MIBG, as measured by the kidney/background ratio, was 2.7 (0.4) (mean (SD)), 2.7 (0.5), and 2.5 (0.4) at 1, 3, and 6 months post-transplantation, respectively, as compared with the 4.0 (0.4) value in the donor kidney before donor nephrectomy (p < 0.01). There was no significant change in washout-rate between pre-transplantation and any of the follow-up time points. Living donor kidney transplantation was at 6 months post transplantation, associated with an almost 40% reduction in the relative 4 h 123I-MIBG uptake of the kidney. Further studies will help to fully establish its implications as a marker of renal innervation or denervation.

Nerve regeneration in transplanted organs and tracer imaging studies: A review

“…In addition, Rasmussen et al observed a 30% reduction in 123 I-mIBG uptake by the transplanted kidney 1 month later compared to 123 I-mIBG uptake by the donor kidney within 4 h preoperatively ( p < 0.005). This illustrates a positive correlation between recovery of renal function in the transplanted kidney and renal reinnervation ( Rasmussen et al, 2020 ).…”

Efficacy and safety of Sodium-Glucose-Transporter-2 inhibitors in kidney transplant patients

“…This early dip is believed to represent a reduced glomerular filtration pressure due to a constrictive adaptation of the afferent arteriole [22]. It has been believed that the transplanted kidney is denervated, although signs of nerve growth have been shown at the anastomosis site of the renal artery [42][43][44][45]. Nevertheless, the transplanted kidney seems to respond hemodynamically as do native kidneys after SGLT2i.…”

Contribuição da cintilografia com metaiodobenzilguanidia-123 na predição da resposta pressórica e na quantificação da denervação simpática renal em pacientes com hipertensão arterial sistêmica resistente

“…O rim transplantado, modelo de denervação completa, apresenta captação de MIBG-123I marcadamente menor em comparação com o pré-transplante. Mas a relação rim-radiação de fundo é reduzida em apenas 30-40% em comparação com o rim inervado (104). Esses achados são até certo ponto esperados, já que não conseguimos diferenciar entre os componentes vasculares, urinários, parenquimatosos e neuronais da captação renal de MIBG-123I.…”