Prognostic Value of Dynamic Tissue Perfusion Measurements in Transplanted Kidneys

Background: The dynamic tissue perfusion measurement in renal transplants has demonstrated its potential to correlate microvascular perfusion changes with histologic changes in the renal cortex [1]. It has shown in cross sectional studies that the cortical perfusion depends on the time elapsed after transplantation [2,3], but has not yet been applied as a prognostic marker. Therefore, we compared in a prospective 6-year study the initial perfusion measurements with the outcome of the graft function. Method: In 78 renal graft recipients, standardized color Doppler sonographic videos were recorded and cortical perfusion was measured in well-defined regions of interest with the PixelFlux-software. Results: In the beginning of the study, prospectively failing grafts (requiring dialysis) had a significantly lower cortical perfusion compared to grafts with preserved function (0.40 vs. 0.57 cm/s average perfusion intensity of the entire cortex). The interval between perfusion measurement and graft failure was 2.17 years (0 - 6 years). Conclusion: Thus, dynamic tissue perfusion measurement may have a role in the prospective evaluation of renal transplant function. Summary: In 78 transplant recipients, we could demonstrate the prognostic potential of the dynamic color Doppler sonographic perfusion measurement of renal transplants. Perfusion was significantly diminished in those grafts that failed later on within a 6-year period. Thus, cortical perfusion measurement might be valuable as a non-invasive prospective method which reflects the state of the cortical microvasculature.

A comparative study of pancreas transplantation between type 1 and 2 diabetes mellitus

Background:Pancreas transplantation remains the best long-term treatment option to achieve physiological euglycemia and insulin independence in patients with labile diabetes mellitus(DM).It is widely accepted as an optimal procedure for type 1 DM(T1DM),but its application in type 2 DM(T2DM)is not unanimously acknowledged.Methods:In total,146 diabetes patients undergoing pancreas transplantation were included in this study.Clinical data and outcomes were compared between the T1DM and T2DM groups.Results:Majority(93%)of the pancreas transplantations in T2DM were for uremic recipients.Complications occurred in 106(73%)patients,including 70(48%)with early complications before discharge and 79(54%)with late complications during follow-up period.Overall,rejection of pancreas graft occurred in 37(25%)patients.Total rejection rate in T2DM recipients was significantly lower than that in T1DM.The short-and long-term outcomes for endocrine function in terms of fasting blood sugar and hemoglobin A1c levels and graft survival rates are comparable between the T2DM and T1DM groups.Conclusions:T2DM is not inferior to T1DM after pancreas transplantation in terms of surgical risks,immunological and endocrine outcomes,and graft survival rates.Therefore,pancreas transplantation could be an effective option to treat selected uremic T2DM patients without significant insulin resistance.