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Prediction of acute rejection in renal allografts using shear-wave dispersion slope

  • Ultrasound
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

To evaluate the role of shear-wave dispersion slope for predicting renal allograft dysfunction.

Methods

We retrospectively reviewed 128 kidney transplant recipients (median age, 55 years [interquartile range, 43–62 years]; male, 68) who underwent biopsy for allograft evaluation from November 2022 to February 2023. Cortex and renal sinus fat stiffness and shear-wave dispersion slope were obtained at shear-wave elastography (SWE). Cortex-to-sinus stiffness ratio (SR) and dispersion slope ratio (DSR)–related clinical and pathologic factors were evaluated using multivariable linear regression analysis. We conducted univariate and multivariate analyses for multiparametric ultrasound (US) parameters for identifying acute rejection and calculated the area under the receiver operating curve (AUC) values.

Results

Of 128 patients, 31 (24.2%) demonstrated acute rejection. The SR value did not differ between patient groups (1.21 vs. 1.20, p = 0.47). Patients with acute rejection demonstrated a higher DSR than those without rejection (1.4 vs. 1.21, p < 0.01). Interstitial fibrosis and tubular atrophy grade (IFTA; coefficient, 0.11/grade; p = 0.04) and renal transplant and biopsy interval (coefficient, 0.00007/day; p = 0.03) were SR determinant factors, whereas only IFTA grade (coefficient, 0.10/grade; p = 0.01) for DSR. Multivariate analysis revealed mean resistive index (odds ratio [OR] 1.08, 95% confidence interval [CI] 1.02–1.14, p = 0.01) and DSR value (OR 16.0, 95% CI 3.0–85.8, p = 0.001) as independent factors for predicting acute rejection. An AUC of 0.74 for detecting acute rejection was achieved by combining the resistive index and DSR value.

Conclusion

Shear-wave dispersion slope obtained at SWE may help identify renal allograft dysfunction.

Clinical relevance statement

Acute rejection in renal allografts is a major cause of allograft failure, but noninvasive diagnosis is a challenge. Shear-wave dispersion slope can identify acute rejection non-invasively.

Key Points

• The interstitial fibrosis and tubular atrophy grade was a determinant factor for stiffness ratio and shear-wave dispersion slope ratio between cortex and renal sinus fat.

• Shear-wave dispersion slope ratio between cortex and renal sinus fat could identify acute rejection in renal allografts.

• A shear-wave dispersion slope has a potential to reduce unnecessary renal biopsy for evaluating renal allografts.

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Abbreviations

ARFI:

Acoustic radiation force impulse

AUC:

Area under the receiver operating characteristic curve

DSR:

Cortex-to-renal sinus fat dispersion slope ratio

IFTA:

Interstitial fibrosis and tubular atrophy

NPV:

Negative predictive value

PPV:

Positive predictive value

RI:

Resistive index

ROI:

Region of interest

SR:

Cortex-to-renal sinus fat stiffness ratios

SWE:

Shear-wave elastography

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Funding

The authors state that this work has not received any funding.

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Authors and Affiliations

  1. Department of Radiology, Seoul National University Hospital, Seoul, South Korea

    Taek Min Kim, Jeong Yeon Cho & Sang Youn Kim

  2. Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea

    Taek Min Kim, Hyungwoo Ahn, Jeong Yeon Cho & Sang Youn Kim

  3. Department of Radiology, Seoul National University Bundang Hospital, Seongnam, South Korea

    Hyungwoo Ahn

  4. Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea

    Ahram Han, Sang-Il Min & Jongwon Ha

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Correspondence to Sang Youn Kim.

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The scientific guarantor of this publication is Sang Youn Kim.

Conflict of interest

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.

Statistics and biometry

No complex statistical methods were necessary for this paper.

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Written informed consent was waived by the Institutional Review Board.

Ethical approval

This study was approved by the Institutional Review Board of Seoul National University Hospital (IRB no. 2306-218-1446).

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Taek Min Kim and Hyungwoo Ahn contributed equally as first authors.

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Kim, T.M., Ahn, H., Cho, J.Y. et al. Prediction of acute rejection in renal allografts using shear-wave dispersion slope. Eur Radiol (2023). https://doi.org/10.1007/s00330-023-10492-8

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