Early predictive value of baseline renal transplant scintigraphy in pediatric patients

The value of baseline renal transplant scintigraphy (RTS) with technetium-99m diethylenetriaminepentaacetic acid (Tc-DTPA) performed within 2 days after transplantation in predicting early renal transplant outcome in pediatric recipients was assessed in this study.

Baseline RTS of 48 pediatric patients were studied retrospectively. Hilson's perfusion index, graft index (GI), time between peak perfusion and iliac artery (ΔP), and the ratios of peak perfusion to plateau (P : Pl), to peak iliac artery (P : A), and to peak uptake (P : U) were obtained. In 14 patients younger than 9 years old, because of faint visualization of iliac artery, the perfusion indices and GI could not be calculated. The 'Bedside Schwartz' formula was used for calculation of follow-up estimated glomerular filtrate rate (eGFR) values. The need for dialysis in the first week or decreasing serum creatinine of less than 10%/day during 3 consecutive days after the transplantation was accepted as delayed graft function (DGF). The patients, whose creatinine reduction ratio was less than 70% on day 7 after transplantation without DGF, were accepted as slow graft function (SGF).

The means of GI, P : U, and Hilson's perfusion index were significantly high in SGF/DGF (n=10). GI and P : U had very high accuracy in the diagnosis of DGF/SGF (area under the curve>0.90). A strong correlation was found between P : U and same day and between GI and day 15 eGFR values. GI, P : U, and P : A were significant for the prediction of follow-up eGFR of less than 60 ml/min/1.73 m. GI was more accurate than the others.

Our experience in this study underlines the importance of RTS, especially with the use of GI and P : U, which are very valuable in diagnosing DGF/SGF and predicting early transplant outcome in pediatric recipients.