Utility of Shear Wave Elastography for Assessing Allograft Fibrosis in Renal Transplant Recipients: A Pilot Study

To evaluate the utility of ultrasound-based shear wave elastography (SWE) as a noninvasive method to accurately detect and potentially stage the severity of renal allograft fibrosis and assess its user reproducibility.

In this Institutional Review Board-approved, Health Insurance Portability and Accountability Act-compliant prospective study, 70 renal transplant recipients underwent an SWE evaluation of their allograft followed directly by biopsy. Two radiologists performed separate SWE measurement acquisitions and the mean, median, and standard deviation of 10 SWE measurements, obtained separately within the cortex and the medulla, were automatically computed. Each patient's SWE results were subsequently compared to their histologic fibrosis scores. The Fisher exact test and univariate logistic regression models were fit to test for associations between the presence of fibrosis (yes/no) as well as categorical SWE results based on the fibrosis severity, ranging from F0 (no fibrosis) to F3 (severe fibrosis), correlating with histologic scores according to the 2007 Banff classification system. Interobserver and intraobserver correlations were also examined.

Our median medulla SWE values reached statistical significance (P = .04) in association with fibrosis. Furthermore, for every unit increase in the median medulla SWE measurement, the odds of fibrosis increased by approximately 20%. No statistical significance was found for mean cortical, median cortical, or mean medullary SWE values (P = .32, .37, and .06, respectively) in association with fibrosis.

The use of SWE for assessing renal allograft fibrosis is challenging but promising. Further investigation with a larger sample size remains to validate our initial results and establish clinical relevance.