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Nomogram based on high-frequency shear wave elastography (SWE) to evaluate chronic changes after kidney transplantation

  • Ultrasound
  • Published:
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Abstract

Objectives

To construct a nomogram with high-frequency shear wave elastography (SWE) as a noninvasive method to accurately assess chronic changes in renal allografts.

Methods

A total of 191 renal transplantation patients (127 cases in the training group and 64 cases in the verification group) were included in this study. All patients received conventional ultrasound and high-frequency SWE examination, followed directly by biopsy the next day. The chronic changes were divided into mild, moderate, and severe. Multivariate logistic analyses were used to select significant variables, which were used to develop the nomogram. Nomogram models were assessed by receiver operating characteristic (ROC) curves, calibration plots, and decision curve analysis (DCA).

Results

The cutoff value of SWE in mild, moderate, and severe chronic changes was 18.9, 22.5, and 27.6 kPa, respectively. The areas under the curve (AUCs) of SWE in the differential diagnosis of mild and moderate to severe chronic changes and mild to moderate and severe chronic changes were 0.817 and 0.870, respectively. Multivariate analysis showed that time since transplantation, proteinuria, glomerular filtration rate, echogenicity, and SWE were independent diagnostic factors for moderate to severe chronic changes (all p < 0.05); thus, a nomogram was successfully developed. The AUCs of the nomogram in the training and validation groups were 0.905 and 0.938, respectively. The high agreement between the model predictions and the actual observations was confirmed by calibration plot and DCA.

Conclusions

Based on SWE, the nomogram provided an insightful and applicable tool to evaluate chronic changes in renal allografts.

Key Points

• In kidney transplantation, compared with acute changes, chronic changes are significantly correlated with cortical stiffness.

• SWE shows good performance in identifying mild to moderate and severe chronic changes, with an AUC of 0.870.

• Time since transplantation, proteinuria, glomerular filtration rate, echogenicity, and SWE are independent diagnostic factors for moderate to severe chronic changes in renal allografts.

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Abbreviations

AUC:

Area under the curve

DCA:

Decision curve analysis

GFR:

Glomerular filtration rate

ICC:

Intraclass correlation coefficient

IF:

Interstitial fibrosis

PSV:

Peak systolic velocity

RI:

Resistance index

ROC:

Receiver operating characteristic curves

SWE:

Shear wave elastography

TA:

Tubular atrophy

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Funding

This work was supported by Guangdong Basic and Applied Basic Research Foundation (2020A1515010653), National Natural Science Foundation of China (No. 82102047), and the Major Research Plan of the National Natural Science Foundation of China (92059201).

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Author notes

  1. Daopeng Yang and Yan Wang contributed equally to this paper and should be considered co-first authors.

Authors and Affiliations

  1. Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, NO. 58 Zhongshan Road 2, Guangzhou, 510080, People’s Republic of China

    Daopeng Yang, Yan Wang, Bowen Zhuang, Ming Xu, Xiaoyan Xie, Yanling Zheng & Xiaohua Xie

  2. Organ Transplant Center, The First Affiliated Hospital of Sun Yat-Sen University, NO. 58 Zhongshan Road 2, Guangzhou, 510080, People’s Republic of China

    Daopeng Yang, Changxi Wang & Gang Huang

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  1. Daopeng Yang
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Correspondence to Xiaohua Xie.

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The scientific guarantor of this publication is Xiao-hua Xie.

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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

One of the authors (Ming Xu) has significant statistical expertise.

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Written informed consent was approved by the Institutional Review Board.

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The study was approved by the ethics committees of The First Affiliated Hospital of Sun Yat-Sen University.

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Yang, D., Wang, Y., Zhuang, B. et al. Nomogram based on high-frequency shear wave elastography (SWE) to evaluate chronic changes after kidney transplantation. Eur Radiol 33, 763–773 (2023). https://doi.org/10.1007/s00330-022-09054-1

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