Advancements in Elastography for Evaluating Fibrosis in Renal Transplants: Current Perspectives

Renal fibrosis is a leading cause of chronic allograft nephropathy. While renal biopsy remains the gold standard for diagnosing fibrosis, it is an invasive procedure with potential for severe complications. Elastography, an emerging ultrasound imaging technique, appears to be a valuable tool for quantifying tissue stiffness, which correlates with fibrosis. Indeed, numerous studies have demonstrated a strong correlation between increased tissue stiffness, measured by elastography, and the degree of fibrosis detected in biopsy. Over the past few years, various elastography techniques have been evaluated, including strain elastography, shear wave elastography, and acoustic radiation force impulse. However, challenges such as operator dependence, tissue heterogeneity, and the lack of standardized protocols persist. Despite these limitations, elastography presents itself as a valuable tool for the non-invasive monitoring of renal transplant function and could facilitate the early detection of fibrosis, allowing for timely interventions. Future research should focus on standardizing acquisition protocols, establishing robust reference values, and exploring the clinical utility of elastography in guiding therapeutic decisions. The aim of this review is to explore the current state of elastography in the assessment of fibrosis in renal transplantation.