Evaluation of Doppler ultrasound for renal transplant evaluation for - - PowerPoint PPT Presentation

▶

evaluation of doppler ultrasound for renal transplant

Evaluation of Doppler ultrasound for renal transplant evaluation for - - PowerPoint PPT Presentation

Apr 25, 2023 132 likes •468 views

Evaluation of Doppler ultrasound for renal transplant evaluation for renal transplant evaluation ARRS meeting 2011 05 03 F Edward Boas, Terry Desser and Aya Kamaya Terry Desser, and Aya Kamaya Stanford Hospital Disclosure of commercial

slide-1

SLIDE 1

Evaluation of Doppler ultrasound for renal transplant evaluation for renal transplant evaluation

ARRS meeting 2011‐05‐03 F Edward Boas, Terry Desser and Aya Kamaya Terry Desser, and Aya Kamaya Stanford Hospital

slide-2

SLIDE 2

Disclosure of commercial interest Disclosure of commercial interest

Neither I nor my immediate family members Neither I nor my immediate family members have a financial relationship with a commercial organization that may have a commercial organization that may have a direct or indirect interest in the content.

slide-3

SLIDE 3

Diagnoses Diagnoses

Diagnosis Number of patients

1. Normal, with creatinine ≤ 1.5

7

2. Delayed graft function post‐operatively

6 3 Acute rejection 8

3. Acute rejection

8

4. Chronic rejection, transplant

glomerulopathy, or drug toxicity, i i 1 5 5 creatinine > 1.5

5. Hydronephrosis

5

6. Renal vein thrombosis

2

7. Other

14 Total 47

slide-4

SLIDE 4

Resistive index = (V –V

i )/V

Resistive index (Vmax Vmin)/Vmax

y

w velocit

Fl

V V

i

Time

Vmax Vmin

slide-5

SLIDE 5

Resistive index Resistive index

Sensitivity 38% for acute rejection Specificity 63% 30% 35% 40% Normal (0.71 ± 0.11) Acute rejection (0.77 ± 0.11) Other 20% 25% 30% 10% 15% Acute rejection Delayed graft function Renal vein thrombosis 0% 5% <0.7 0.70 – 0.79 0.80 – 0.89 0.90 – 0.99 ≥1 <0.7 0.70 0.79 0.80 0.89 0.90 0.99 ≥1 Resistive index

slide-6

SLIDE 6

Mid renal artery velocity waveform Mid renal artery velocity waveform

slide-7

SLIDE 7

Velocity waveforms Velocity waveforms

30 15 20 25

w (ml/s) — Normal — Acute rejection

5 10 15

artery flow

‐10 ‐5 0.2 0.4 0.6 0.8 1

Renal

10

Fraction of cardiac cycle

slide-8

SLIDE 8

Velocity waveforms Velocity waveforms

30 15 20 25

w (ml/s) — Normal — Acute rejection — Delayed graft function — Chronic rejection

5 10 15

artery flow Chronic rejection — Hydronephrosis — Renal vein thrombosis — Other

‐10 ‐5 0.2 0.4 0.6 0.8 1

Renal

10

Fraction of cardiac cycle

slide-9

SLIDE 9

Velocity waveforms (average) Velocity waveforms (average)

20 15

ml/s) Normal

5 10

tery flow (m Acute rejection

0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9 1

in renal art

‐10 ‐5

Mai Renal vein thrombosis Fraction of cardiac cycle

slide-10

SLIDE 10

Velocity waveforms (Average ± stdev) Velocity waveforms (Average ± stdev)

20

Thick lines: average

15

ml/s) Normal Thick lines: average Thin lines: one standard deviation

5 10

tery flow (m Acute rejection

0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9 1

in renal art

‐10 ‐5

Mai Renal vein thrombosis Fraction of cardiac cycle

slide-11

SLIDE 11

Windkessel model Windkessel model

l Systole Pulsatile pump Continuous capillary flow

Image credits: Piotr Michał Jaworski (kidney) and User ZooFari on Wikipedia (heart). Creative Commons Attribution‐Share Alike 3.0 Unported license.

slide-12

SLIDE 12

Windkessel model Windkessel model

l Systole Pulsatile pump Continuous capillary flow

Image credits: Piotr Michał Jaworski (kidney) and User ZooFari on Wikipedia (heart). Creative Commons Attribution‐Share Alike 3.0 Unported license.

slide-13

SLIDE 13

Windkessel model Windkessel model

l Systole Pulsatile pump Continuous capillary flow

Image credits: Piotr Michał Jaworski (kidney) and User ZooFari on Wikipedia (heart). Creative Commons Attribution‐Share Alike 3.0 Unported license.

slide-14

SLIDE 14

Windkessel model Windkessel model

l Diastole Pulsatile pump Continuous capillary flow

Image credits: Piotr Michał Jaworski (kidney) and User ZooFari on Wikipedia (heart). Creative Commons Attribution‐Share Alike 3.0 Unported license.

slide-15

SLIDE 15

Windkessel model Windkessel model

l Diastole Pulsatile pump Continuous capillary flow

Image credits: Piotr Michał Jaworski (kidney) and User ZooFari on Wikipedia (heart). Creative Commons Attribution‐Share Alike 3.0 Unported license.

slide-16

SLIDE 16

Windkessel model Windkessel model

l Diastole Pulsatile pump Continuous capillary flow

Image credits: Piotr Michał Jaworski (kidney) and User ZooFari on Wikipedia (heart). Creative Commons Attribution‐Share Alike 3.0 Unported license.

slide-17

SLIDE 17

3‐element Windkessel model 3 element Windkessel model

R1 Pre‐glomerular resistance (renal artery) C Vascular compliance R2 Post‐glomerular resistance (renal vein)

slide-18

SLIDE 18

3‐element Windkessel model 3 element Windkessel model

slide-19

SLIDE 19

Normal Normal

slide-20

SLIDE 20

High R1 High R1

slide-21

SLIDE 21

Normal Normal

slide-22

SLIDE 22

High R2 High R2

slide-23

SLIDE 23

Normal Normal

slide-24

SLIDE 24

Low C Low C

slide-25

SLIDE 25

3‐element Windkessel model

250 7 150 200

2

4 5 6

C

50 100

R2

1 2 3

C

10 20 30

R1

10 20 30

R1

7 4 5 6

Normal Acute rejection Delayed graft function Chronic rejection

1 2 3

C Chronic rejection Hydronephrosis Renal vein thrombosis Other

50 100 150 200 250

R2

slide-26

SLIDE 26

3‐element Windkessel model

250 7 150 200

2

4 5 6

C Renal vein thrombosis

50 100

R2

1 2 3

C

10 20 30

R1

10 20 30

R1

7 4 5 6

Normal Acute rejection Delayed graft function Chronic rejection

1 2 3

C Chronic rejection Hydronephrosis Renal vein thrombosis Other

50 100 150 200 250

R2

slide-27

SLIDE 27

Doppler ultrasound Doppler ultrasound

Acute rejection can’t be diagnosed using: Acute rejection can t be diagnosed using:

resistive index (intra‐renal)

l l i

pre‐glomerular resistance
post‐glomerular resistance
vascular compliance
the shape of the velocity waveform (mid renal

the shape of the velocity waveform (mid renal artery)

slide-28

SLIDE 28

Conclusions Conclusions

Doppler ultrasound of kidney transplants has

Doppler ultrasound of kidney transplants has limited value in diagnosing acute rejection.

Resistive index > 0 9 is seen in acute rejection
Resistive index > 0.9 is seen in acute rejection,

delayed graft function, and renal vein thrombosis thrombosis.

The 3‐element Windkessel model can be used

d i l i d to determine vascular resistance and compliance.

slide-29

SLIDE 29

Additional slides Additional slides

slide-30

SLIDE 30

3‐element Windkessel model 3 element Windkessel model

Resistive index is increased with: Resistive index is increased with:

Increased R2 (post‐glomerular resistance)

d ( l l i )

Decreased R1 (pre‐glomerular resistance)
Increased C (vascular compliance)
Increased pulse pressure
Increased heart rate

Increased heart rate

slide-31

SLIDE 31

Principal component analysis Principal component analysis

Average waveform Principal components

12 0.25

Flow

Average waveform Principal components

6 8 10

w (ml/s)

0.05 0.1 0.15 0.2

ml/s)

Biphasic pulsatility Triphasic pulsatility

2 4 6

Flow

‐0.15 ‐0.1 ‐0.05 0.2 0.4 0.6 0.8 1

Flow (m

0.2 0.4 0.6 0.8 1

Fraction of cardiac cycle

‐0.25 ‐0.2

Fraction of cardiac cycle

slide-32

SLIDE 32

Principal component analysis

30 40 50 60 70

lsatility

5 10 15 20

ulsatility

‐10 10 20 ‐50 50 100

Biphasic pu

‐20 ‐15 ‐10 ‐5 ‐50 50 100

riphasic pu

‐30 ‐20

B Flow

‐30 ‐25

Tr Flow

20 5 10 15 20

ulsatility Normal Acute rejection Delayed graft function Chronic rejection

25 ‐20 ‐15 ‐10 ‐5 ‐50 50 100

Triphasic pu Chronic rejection Hydronephrosis Renal vein thrombosis Other

‐30 ‐25

T Biphasic pulsatility