Am. Alnahhas et al., CELLULAR VERSUS VASCULAR REJECTION IN TRANSPLANT KIDNEYS - CORRELATION OF RADIONUCLIDE AND DOPPLER STUDIES WITH HISTOLOGY, Nuclear medicine communications, 14(9), 1993, pp. 761-765
The presence of two distinct subtypes of renal allograft rejection are
well documented by histological studies. The differentiation between
vascular rejection (VR) and cellular rejection (CR) is essential for p
roper management by avoiding the need for unnecessary and potentially
harmful immunosuppressive treatment of VR. A histological pattern with
features that are similar and confusable with some cases of rejection
may be seen in cyclosporin A toxicity (CyT). To evaluate the efficien
cy of Guy's perfusion index (GPI) and the Doppler pulsatility index (D
PI) in differentiating these two histological subtypes, a prospective
study was designed in which a total of 140 radionuclide tests and 133
ultrasounds scans performed on the same day on 58 patients during the
first 3 months post-transplant were analysed, and the results correlat
ed with the histological findings of 84 renal biopsies. Results show t
hat the GPI had a sensitivity of 86.5% and a specificity of 94% in dif
ferentiating VR and CyT from CR, while the DPI had values of 83% and 6
9%, respectively. Chi-squared analysis showed a higher significant ass
ociation between the GPI and histology (P < 0.0001) compared to that o
f the DPI and histology (P < 0.005), while Youden's index (J) showed a
significant difference (P < 0.05) between GPI and DPI. It is conclude
d that GPI is more sensitive and specific than DPI in differentiating
transplants that are well perfused from those with poor perfusion (VR
and CyT).