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During posttransplant acute renal failure (ARF), the diagnosis of allograft rejection constitutes a major problem. We evaluated the value of Doppler ultrasonography in identifying grafts at risk of rejection during ARF. In 184 recipients of a renal allograft, Doppler examinations were performed on the first and fifth postoperative day. Doppler spectra were quantitatively analyzed with a user-written computer program. Doppler findings were not used in clinical decision making. ARF was defined as a diuresis < 400 ml/24 hr and/or the necessity for dialysis. Doppler spectra obtained on the first day after transplantation showed a resistance index (RI) of 0.59 +/- 0.09 in recipients with immediately functioning cadaveric grafts (n = 123), while living related donor grafts (n = 20) showed a lower RI (0.55 +/- 0.07; P < 0.05). Grafts with ARF (n = 41) showed a considerably higher RI (0.67 +/- 0.13; P < 0.05). When grafts with a duration of ARF < or = 4 days (n = 17) were compared with ARF > 4 days (n = 24), RI was not significantly different (0.63 +/- 0.07 vs. 0.68 +/- 0.15; NS). However, the acceleration time of the systolic deflection of the spectrum waveform (Tmax) was shorter in grafts with ARF > 4 days (86 +/- 47 msec vs. 128 +/- 39 msec; P < 0.05). On the fifth day after transplantation, Doppler spectra in grafts with ARF > 4 days (n = 24) showed a Tmax < 90 msec in 9 patients, 8 of whom experienced rejection during ARF (positive predictive value, 8/9 = 89%). In the 15 patients with Tmax > or = 90 msec, only 2 rejections occurred (negative predictive value, 13/15 = 87%). For the RI (> 0.85), positive predictive value was 4/5 = 80% and negative predictive value (RI < or = 0.85) was 13/19 = 68%. In conclusion, a short acceleration time of the Doppler waveform on the first day after transplantation is associated with a longer duration of ARF. Quantitative analysis of Doppler spectra can be helpful in the identification of patients at risk for rejection and in the timing of allograft biopsy during ARF. Persistently short Tmax values on the fifth day after transplantation perform better in identifying grafts at risk of rejection than high RI values.
J W Merkus, and
A J Hoitsma, and
W N van Asten, and
R A Koene, and
S H Skotnicki
March 1997,
Renal failure,
J W Merkus, and
A J Hoitsma, and
W N van Asten, and
R A Koene, and
S H Skotnicki
April 1997,
Pediatric nephrology (Berlin, Germany),
J W Merkus, and
A J Hoitsma, and
W N van Asten, and
R A Koene, and
S H Skotnicki
January 1970,
Transplantation,
J W Merkus, and
A J Hoitsma, and
W N van Asten, and
R A Koene, and
S H Skotnicki
August 1995,
Transplantation proceedings,
J W Merkus, and
A J Hoitsma, and
W N van Asten, and
R A Koene, and
S H Skotnicki
November 2005,
Australian family physician,
J W Merkus, and
A J Hoitsma, and
W N van Asten, and
R A Koene, and
S H Skotnicki
December 2009,
Experimental and clinical transplantation : official journal of the Middle East Society for Organ Transplantation,
J W Merkus, and
A J Hoitsma, and
W N van Asten, and
R A Koene, and
S H Skotnicki
May 1999,
Journal of clinical ultrasound : JCU,
J W Merkus, and
A J Hoitsma, and
W N van Asten, and
R A Koene, and
S H Skotnicki
February 1989,
Transplantation proceedings,
J W Merkus, and
A J Hoitsma, and
W N van Asten, and
R A Koene, and
S H Skotnicki
August 2003,
Journal of the American Society of Nephrology : JASN,
J W Merkus, and
A J Hoitsma, and
W N van Asten, and
R A Koene, and
S H Skotnicki
January 1993,
The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation,
