Role of shear wave elastography in assessment of chronic allograft nephropathy

Abstract

Abstract Background The principal cause of renal graft loss after the first year is chronic allograft nephropathy which is represented histologically by tubulo-interstitial fibrosis. Its early diagnosis and treatment are crucial to prevent late graft failure. Ultrasound is unequivocally the first-line imaging modality for the evaluation of renal transplants in the immediate postoperative period and for long-term follow-up. Ultrasound shear wave elastography is an imaging technique based on estimation of the elastic properties of tissues. Elastography is performed in the same clinical setting with conventional B-mode ultrasonography. Tissue elasticity is displayed as an absolute number and color-coded real-time estimation. So, it can be used in screening and diagnosing chronic allograft nephropathy. However, the accurate diagnosis and prognosis of renal parenchymal complications still relies on tissue biopsy. Many studies have proved the high specificity of ultrasound elastography in decreasing the number of unnecessary biopsies. Results In our study, we included 36 patients with biopsy-proven chronic allograft nephropathy. All patients had a B-mode ultrasound examination and followed by ultrasound shear wave elastography in the same session. The results were compared to the histopathological results. Time since transplantation was directly correlated with mean renal stiffness, revealing that with longer time of transplantation renal stiffness and interstitial fibrosis and tubular atrophy (IF/TA) percentage increased with r = 0.72, 0.90 and p value < 0.001. Antero-posterior (AP) diameter of the renal graft was significantly correlated with mean renal stiffness as the larger the AP diameter, the higher the mean kidney stiffness with r = 0.47, 0.73 and p value 0.001. Sensitivity analysis showed that US shear wave elastography through mean kidney stiffness can significantly predict moderate Banff score of renal fibrosis using cutoff value 28.67 kPa with sensitivity 87.5%, specificity 90%, AUC 0.91 and p value < 0.001. Conclusion Shear wave elastography (SWE) may be useful for the prediction of fibrosis in renal transplant patients, especially in the case of moderate Banff score, where the accuracy reached 87.5% using a cutoff value 28.67 kPa. We conclude that US SWE can be of great help during the regular follow-up of renal transplant patients. It can act as a screening tool to identify patients with stiffness values that suggest moderate tubulo-interstitial fibrosis, so eventually helping in the early diagnosis, management and help in selecting patients who are candidate for biopsy and in avoiding the repeated unnecessary biopsies for others.

Keywords

• Ultrasound
• Shear wave elastography
• Renal transplant
• Chronic graft dysfunction
• Chronic allograft nephropathy