Prospective study of ASL and T1-mapping to assess renal function at different stages of early graft dysfunction from...

This study evaluated renal perfusion and T1-mapping parameters for diagnosing early graft dysfunction (EGD) and analyzed their correlation with renal function within 6 months post-transplantation. An exploratory analysis also examined temporal changes in MRI parameters across renal recovery stages.

This prospective study included 43 renal transplant recipients, having EGD (n = 20) or initial graft function (IGF, n = 23). EGD was subdivided into delayed graft function, defined as the need for dialysis within the first week (n = 9), and slow graft function, defined as a daily serum creatinine reduction of < 10% for three consecutive days without dialysis (n = 11). All participants underwent arterial spin labeling (ASL) and T1-mapping MRI to quantify renal blood flow (RBF), T1 values, and corticomedullary differentiation (CMD). Correlation analyses and receiver operating characteristic curves were employed for statistical assessment.

In the EGD group, RBF and CMD were significantly positively correlated with estimated glomerular filtration rate (eGFR) on the MRI day and at 3 months. The combination of three models integrating the high specificity of cortical RBF (0.950) and the high sensitivity of eGFR (1.00) significantly enhanced diagnostic efficacy (AUC = 0.983).

Compared with IGF patients, EGD patients exhibited reduced perfusion and altered tissue microstructure. The combined MRI parameters demonstrated promising diagnostic performance for EGD. These findings support the feasibility of ASL for noninvasive early monitoring and warrant validation in larger longitudinal cohorts.