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. 2020 Jan;30(1):452-460.
doi: 10.1007/s00330-019-06334-1. Epub 2019 Jul 23.

Limited clinical value of two consecutive post-transplant renal scintigraphy procedures

Stan Benjamens  1   2   3 , Robert A Pol  4 , Stefan P Berger  5 , Andor W J M Glaudemans  6 , Petra Dibbets-Schneider  7 , Riemer H J A Slart  6   8 , Lioe-Fee de Geus-Oei  7   8
Affiliations

Limited clinical value of two consecutive post-transplant renal scintigraphy procedures

Stan Benjamens et al. Eur Radiol. 2020 Jan.

Abstract

Objectives: Duration of delayed graft function (DGF) and length of hospital stay (LOS) are outcomes of interest in an era that warrants increased efficacy of transplant care whereas renal allografts originate increasingly from marginal donors. While earlier studies investigate the predictive capability of a single renal scintigraphy, this study focuses on the value for both DGF duration and LOS of consecutively performed scintigraphies.

Methods: From 2011 to 2014, renal transplant recipients referred for a Tc-99m MAG3 renal scintigraphy were included in a single-center retrospective study. Primary endpoints were DGF duration and LOS. Both the first (≤ 3 days) and second scintigraphies (3-7 days after transplantation) were analyzed using a 4-grade qualitative scale and quantitative indices (TFS, cTER, MUC10, average upslope).

Results: We evaluated 200 first and 108 (54%) consecutively performed scintigraphies. The Kaplan-Meier curves for DGF duration and qualitative grading of the first and second scintigraphy showed significant differences between the grades (p < 0.01). The Kaplan-Meier curve for the delta grades between these procedures (lower, equal, or higher grade) did not show significant differences (p = 0.18). Multivariate analysis showed a significant association between the qualitative grades, from the first and second scintigraphy, and DGF duration, HR 1.8 (1.4-2.2, p < 0.01) and 2.8 (1.8-4.3, p < 0.01), respectively.

Conclusions: Qualitative grades of single renal scintigraphies, performed within 7 days after transplantation, can be used to make a reliable image-guided decision on the need for dialysis and to predict LOS. A consecutive renal scintigraphy, however, did not show an additional value in the assessment of DGF.

Key points: • Post-transplant renal scintigraphy procedures provide information to predict delayed graft function duration and length of hospital stay. • Performing two consecutive renal scintigraphy procedures within 1 week after transplantation does not strengthen the prediction of delayed graft function duration and length of hospital stay. • Single renal scintigraphy procedures can be used to provide clinicians and patients with a reliable indication of the need for dialysis after transplantation and the expected duration of hospitalization.

Keywords: Delayed graft function; Kidney transplantation; Length of stay; Radionuclide imaging.

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Conflict of interest statement

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Figures

Fig. 1
Fig. 1
Qualitative renal scintigraphy grading: grade 1, a normal renal function with fast uptake and excretion; grade 2, a normal uptake with flat excretion curve; grade 3, a rising curve without excretion phase; grade 4, a reduced absolute uptake without excretion phase [21]
Fig. 2
Fig. 2
Flowchart of the included patients
Fig. 3
Fig. 3
The Kaplan-Meier curves for qualitative grading
See this image and copyright information in PMC

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