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Published on: April 28, 2013
Prediction of long-term renal transplant allograft function from day 3 post-transplant Tc-99m MAG3 scintigraphy
Stanley Ngai1, Timothy Demetriades
1Department of Radiology, Princess Alexandra Hospital, Brisbane, Queensland, Australia. sngai01@hotmail.com
Insights
Day 3 post-transplant perfusion index and early serum creatinine levels can predict long-term kidney transplant outcomes. These markers show a strong relationship with later serum creatinine levels, aiding in predicting allograft survival.
Area of Science:
- Nephrology
- Transplant Surgery
- Nuclear Medicine
Background:
- Long-term renal allograft survival is crucial after transplantation.
- Serum creatinine (sCr) levels at 1 year post-transplant are predictive of outcomes.
- Tc-99m MAG3 scans with Hilson's perfusion index (PI) are routinely used on day 3 post-transplant.
Purpose of the Study:
- To evaluate the predictive power of day 3 post-transplant Hilson's PI for long-term sCr levels.
- To assess early sCr levels (1 or 3 months) for predicting 12-month sCr levels.
- To explore markers for predicting long-term renal allograft survival.
Main Methods:
- Retrospective analysis of 108 renal transplant patients (April 2001-March 2002).
- Recorded sCr levels at 1, 3, 12 months, and 5 years post-transplantation.
- Compared sCr levels with day 3 post-transplant Hilson's PI.
Main Results:
- Hilson's PI showed 72-74% accuracy and 90% sensitivity in predicting sCr levels up to 12 months.
- Significant correlation (R=0.32-0.39, P=0.00002-0.003) between Hilson's PI and sCr, but with low specificity.
- Early sCr levels (1 or 3 months) strongly predicted 12-month sCr levels (R=0.68-0.85, P<0.000001).
Conclusions:
- A strong relationship exists between day 3 Hilson's PI and serial sCr levels post-transplantation.
- Early sCr levels (1 and 3 months) are strongly related to 12-month sCr levels.
- A composite index integrating these markers warrants investigation for predicting long-term renal allograft survival.
Purpose:
Serum creatinine (sCr) levels of >1.5mg/dL or >130 ummol/L at 1 year after renal transplantation were strongly predictive of long-term allograft survival. A Tc-99m MAG3 study with a Hilson's perfusion index (PI) is routinely performed on day 3 post-transplantation at Princess Alexandra Hospital, Australia. The predictive power of day 3 post-transplantation Hilson's PI for long-term sCr levels; and early sCr levels (at 1 or 3 months) to predict sCr levels at 12 months post-transplantation were studied.
Materials And Methods:
One hundred eight patients receiving renal transplantation from April 2001 to March 2002 were retrospectively analyzed. sCr levels at 1, 3, and12 months, and 5 years after renal transplantation were recorded and compared with the day 3 post-transplantation Hilson's PI.
Results:
Accuracy of 72% to 74%, and 90% sensitivity were recorded between Hilson's PIs and sCr levels up to 12-month post-transplantation. Spearman's correlation shows a significant relationship (R = 0.32-0.39, P = 0.00002-0.003). However, the association seems to have low specificity. A significant relationship was found for early sCr levels (at 1 or 3 months) to predict sCr levels at 12-month post-transplantation, with a Spearman correlation coefficient (R = 0.68-0.85, P < 0.000001).
Conclusion:
There is a strong relationship between the day 3 Hilson's PIs and serial sCr levels post-transplantation, and between the early sCr levels (1 and 3 months), and the 12 months sCr levels post-transplantation. A composite index integrating these 2 markers to predict long-term renal allograft survival remains to be investigated.
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