超声造影在供肾质量评估中的应用

董尚鑫; 施辉波; 赵圆圆; 李开艳; 罗鸿昌; 张波; 陈知水; 蒋继贫

doi:10.3969/j.issn.1674-7445.2022.05.020

超声造影在供肾质量评估中的应用

doi: 10.3969/j.issn.1674-7445.2022.05.020

430030 武汉，华中科技大学同济医学院附属同济医院器官移植研究所器官移植教育部重点实验室国家卫生健康委员会器官移植重点实验室中国医学科学院器官移植重点实验室(董尚鑫、施辉波、赵圆圆、张波、陈知水、蒋继贫); 华中科技大学同济医学院附属同济医院超声影像科(李开艳、罗鸿昌)

基金项目:

四川省教育厅2020年度社会科学项目 YF20-Y05

详细信息

作者简介:

通讯作者:
蒋继贫，博士，副教授，主任医师，研究方向为肾移植、肝移植，Email：jpjiang@tjh.tjmu.edu.cn

中图分类号: R617, R445.1
计量
- 文章访问数: 248
- HTML全文浏览量: 118
- PDF下载量: 82
- 被引次数: 0
出版历程
- 收稿日期: 2022-04-19
- 网络出版日期: 2022-09-14
- 刊出日期: 2022-09-15

Application of contrast-enhanced ultrasound in evaluation of donor kidney quality

Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Key Laboratory of Organ Transplantation of Ministry of Education, Key Laboratory of Organ Transplantation of National Health Commission of China, Key Laboratory of Organ Transplantation of Chinese Academy of Medical Sciences, Wuhan 430030, China

More Information

Corresponding author: Jiang Jipin, Email: jpjiang@tjh.tjmu.edu.cn

摘要

摘要: 近年来，我国公民逝世后器官捐献数量不断增加，但每年仍有大量的终末期肾病患者等待肾移植，供需不平衡仍是目前影响临床肾移植工作开展的主要问题之一。因此，准确评估供肾质量，充分利用扩大标准供肾具有十分重要的临床意义。超声造影因其安全、便携、实时、可量化等特点，已逐步应用于各类实体器官的检测，其在供肾质量评估方面也具有良好的应用前景。本文将从当前供肾评估方法的优势与局限性及超声造影应用于供肾评估的现状及优势进行综述，探讨超声造影在供肾质量评估中的应用前景，增加供肾评估的方法和准确性，为合理利用扩大标准供肾提供参考。
- 超声造影 /
- 肾移植 /
- 供肾评估 /
- 扩大标准供者 /
- 边缘供肾 /
- 供肾评分系统 /
- 活组织检查 /
- 低温机械灌注
Abstract: In recent years, although the quantity of organ donation after citizen's death has been constantly increased, a large number of patients with end-stage renal diseases are waiting for kidney transplantation every year. The imbalance between donor and recipient is still one of the main problems affecting kidney transplantation in clinical practice. Therefore, it is of clinical significance to accurately evaluate the quality of donor kidney and fully utilize the expanded criteria donor kidney. Contrast-enhanced ultrasound has been gradually applied in the detection of multiple solid organs due to its safety, portability, real-time detection, quantification and other characteristics, and it also has promising application prospect in the evaluation of donor kidney quality. In this article, the advantages and limitations of current evaluation methods for donor kidney and current status and advantages of contrast-enhanced ultrasound in donor kidney evaluation were reviewed, and the application prospect of contrast-enhanced ultrasound in the evaluation of donor kidney quality was discussed, aiming to increase the methods and enhance the accuracy for donor kidney evaluation, and provide reference for rational use of expanded criteria donor kidney.
- Contrast-enhanced ultrasonography /
- Kidney transplantation /
- Donor kidney evaluation /
- Expanded criteria donor /
- Marginal donor kidney /
- Donor kidney scoring system /
- Biopsy /
- Hypothermic mechanical perfusion

HTML全文

下载: 全尺寸图片幻灯片

表 1 供肾零点穿刺活检病理评分标准的优势与局限性比较

Table 1. Comparison of advantages and limitations of pathological scoring criteria for donor kidney zero point biopsy

名称	评估参数	优势	局限性
Banff标准	肾小球硬化、肾间质纤维化、肾小管坏死、小动脉透明样变、血管内膜增厚	提供较为准确的供肾信息	缺乏对零点活检中炎症反应的诊断价值
Remuzzi评分	肾小球硬化、肾间质纤维化、肾小管萎缩、肾血管病变程度	可用于术前评估肾移植方式，如单肾移植、双肾移植、丢弃	无法预测移植物存活率，且4种病变对移植物术后影响占比相同
MAPI	肾小球硬化、肾小球周围纤维化、小动脉玻璃样变、血管管腔缩小比	可用于估计移植物存活率	无法为肾移植方式的选择提供帮助，不能外推到肾小球硬化率 > 25%的情况

下载: 导出CSV

参考文献(31)

[1]	COEMANS M, SÜSAL C, DÖHLER B, et al. Analyses of the short- and long-term graft survival after kidney transplantation in Europe between 1986 and 2015[J]. Kidney Int, 2018, 94(5): 964-973. DOI: 10.1016/j.kint.2018.05.018.
[2]	NYBERG SL, MATAS AJ, KREMERS WK, et al. Improved scoring system to assess adult donors for cadaver renal transplantation[J]. Am J Transplant, 2003, 3(6): 715-721. DOI: 10.1034/j.1600-6143.2003.00111.x.
[3]	ANGLICHEAU D, LOUPY A, LEFAUCHEUR C, et al. A simple clinico-histopathological composite scoring system is highly predictive of graft outcomes in marginal donors[J]. Am J Transplant, 2008, 8(11): 2325-2334. DOI: 10.1111/j.1600-6143.2008.02394.x.
[4]	RAO PS, SCHAUBEL DE, GUIDINGER MK, et al. A comprehensive risk quantification score for deceased donor kidneys: the kidney donor risk index[J]. Transplantation, 2009, 88(2): 231-236. DOI: 10.1097/TP.0b013e3181ac620b.
[5]	CLAYTON PA, DANSIE K, SYPEK MP, et al. External validation of the US and UK kidney donor risk indices for deceased donor kidney transplant survival in the Australian and New Zealand population[J]. Nephrol Dial Transplant, 2019, 34(12): 2127-2131. DOI: 10.1093/ndt/gfz090.
[6]	PETERS-SENGERS H, HEEMSKERK MBA, GESKUS RB, et al. Validation of the prognostic kidney donor risk index scoring system of deceased donors for renal transplantation in the Netherlands[J]. Transplantation, 2018, 102(1): 162-170. DOI: 10.1097/TP.0000000000001889.
[7]	ZHONG Y, SCHAUBEL DE, KALBFLEISCH JD, et al. Reevaluation of the kidney donor risk index[J]. Transplantation, 2019, 103(8): 1714-1721. DOI: 10.1097/TP.0000000000002498.
[8]	LIAPIS H, GAUT JP, KLEIN C, et al. Banff histopathological consensus criteria for preimplantation kidney biopsies[J]. Am J Transplant, 2017, 17(1): 140-150. DOI: 10.1111/ajt.13929.
[9]	REMUZZI G, GRINYÒ J, RUGGENENTI P, et al. Early experience with dual kidney transplantation in adults using expanded donor criteria. Double Kidney Transplant Group (DKG)[J]. J Am Soc Nephrol, 1999, 10(12): 2591-2598. DOI: 10.1681/ASN.V10122591.
[10]	MUNIVENKATAPPA RB, SCHWEITZER EJ, PAPADIMITRIOU JC, et al. The Maryland aggregate pathology index: a deceased donor kidney biopsy scoring system for predicting graft failure[J]. Am J Transplant, 2008, 8(11): 2316-2324. DOI: 10.1111/j.1600-6143.2008.02370.x.
[11]	YAP YT, HO QY, KEE T, et al. Impact of pre-transplant biopsy on 5-year outcomes of expanded criteria donor kidney transplantation[J]. Nephrology (Carlton), 2021, 26(1): 70-77. DOI: 10.1111/nep.13788.
[12]	PHILLIPS BL, KASSIMATIS T, ATALAR K, et al. Chronic histological changes in deceased donor kidneys at implantation do not predict graft survival: a single-centre retrospective analysis[J]. Transpl Int, 2019, 32(5): 523-534. DOI: 10.1111/tri.13398.
[13]	GIROLAMI I, GAMBARO G, GHIMENTON C, et al. Pre-implantation kidney biopsy: value of the expertise in determining histological score and comparison with the whole organ on a series of discarded kidneys[J]. J Nephrol, 2020, 33(1): 167-176. DOI: 10.1007/s40620-019-00638-7.
[14]	MAZZUCCO G, MAGNANI C, FORTUNATO M, et al. The reliability of pre-transplant donor renal biopsies (PTDB) in predicting the kidney state. a comparative single-centre study on 154 untransplanted kidneys[J]. Nephrol Dial Transplant, 2010, 25(10): 3401-3408. DOI: 10.1093/ndt/gfq166.
[15]	VONBRUNN E, ANGELONI M, BÜTTNER-HEROLD M, et al. Can gene expression analysis in zero-time biopsies predict kidney transplant rejection?[J]. Front Med (Lausanne), 2022, 9: 793744. DOI: 10.3389/fmed.2022.793744.
[16]	SALINAS SJF, PÉREZ RE, LÓPEZ MC, et al. Impact of cold ischemia time in clinical outcomes in deceased donor renal transplant[J]. Transplant Proc, 2020, 52(4): 1118-1122. DOI: 10.1016/j.transproceed.2020.02.010.
[17]	HELANTERÄ I, IBRAHIM HN, LEMPINEN M, et al. Donor age, cold ischemia time, and delayed graft function[J]. Clin J Am Soc Nephrol, 2020, 15(6): 813-821. DOI: 10.2215/CJN.13711119.
[18]	ZULPAITE R, MIKNEVICIUS P, LEBER B, et al. Ex-vivo kidney machine perfusion: therapeutic potential[J]. Front Med (Lausanne), 2021, 8: 808719. DOI: 10.3389/fmed.2021.808719.
[19]	MEISTER FA, CZIGANY Z, RIETZLER K, et al. Decrease of renal resistance during hypothermic oxygenated machine perfusion is associated with early allograft function in extended criteria donation kidney transplantation[J]. Sci Rep, 2020, 10(1): 17726. DOI: 10.1038/s41598-020-74839-7.
[20]	COPUR S, YAVUZ F, SAG AA, et al. Future of kidney imaging: functional magnetic resonance imaging and kidney disease progression[J]. Eur J Clin Invest, 2022, 52(5): e13765. DOI: 10.1111/eci.13765.
[21]	CHONG WK, PAPADOPOULOU V, DAYTON PA. Imaging with ultrasound contrast agents: current status and future[J]. Abdom Radiol (NY), 2018, 43(4): 762-772. DOI: 10.1007/s00261-018-1516-1.
[22]	KUTTY S, BIKO DM, GOLDBERG AB, et al. Contrast-enhanced ultrasound in pediatric echocardiography[J]. Pediatr Radiol, 2021, 51(12): 2408-2417. DOI: 10.1007/s00247-021-05119-3.
[23]	LEE SC, TCHELEPI H, KHADEM N, et al. Imaging of benign and malignant breast lesions using contrast-enhanced ultrasound: a pictorial essay[J]. Ultrasound Q, 2022, 38(1): 2-12. DOI: 10.1097/RUQ.0000000000000574.
[24]	JEON SK, LEE JY, KANG HJ, et al. Additional value of superb microvascular imaging of ultrasound examinations to evaluate focal liver lesions[J]. Eur J Radiol, 2022, 152: 110332. DOI: 10.1016/j.ejrad.2022.110332.
[25]	PANG EHT, CHAN A, HO SG, et al. Contrast-enhanced ultrasound of the liver: optimizing technique and clinical applications[J]. AJR Am J Roentgenol, 2018, 210(2): 320-332. DOI: 10.2214/AJR.17.17843.
[26]	OLSON MC, ABEL EJ, MANKOWSKI GETTLE L. Contrast-enhanced ultrasound in renal imaging and intervention[J]. Curr Urol Rep, 2019, 20(11): 73. DOI: 10.1007/s11934-019-0936-y.
[27]	KAZMIERSKI B, DEURDULIAN C, TCHELEPI H, et al. Applications of contrast-enhanced ultrasound in the kidney[J]. Abdom Radiol (NY), 2018, 43(4): 880-898. DOI: 10.1007/s00261-017-1307-0.
[28]	KAZMIERSKI BJ, SHARBIDRE KG, ROBBIN ML, et al. Contrast-enhanced ultrasound for the evaluation of renal transplants[J]. J Ultrasound Med, 2020, 39(12): 2457-2468. DOI: 10.1002/jum.15339.
[29]	JIN Y, YANG C, WU S, et al. A novel simple noninvasive index to predict renal transplant acute rejection by contrast-enhanced ultrasonography[J]. Transplantation, 2015, 99(3): 636-641. DOI: 10.1097/TP.0000000000000382.
[30]	MUELLER-PELTZER K, NEGRÃO DE FIGUEIREDO G, FISCHEREDER M, et al. Vascular rejection in renal transplant: diagnostic value of contrast-enhanced ultrasound (CEUS) compared to biopsy[J]. Clin Hemorheol Microcirc, 2018, 69(1/2): 77-82. DOI: 10.3233/CH-189115.
[31]	RANGANATH PG, ROBBIN ML, BACK SJ, et al. Practical advantages of contrast-enhanced ultrasound in abdominopelvic radiology[J]. Abdom Radiol (NY), 2018, 43(4): 998-1012. DOI: 10.1007/s00261-017-1442-7.