The Renal Arterial Resistance Index and Renal Allograft Survival
Jörg Radermacher, M.D., Michael Mengel, M.D., Sebastian Ellis, M.D., Stephan Stuht, M.D., Markus Hiss, M.D., Anke Schwarz, M.D., Ute Eisenberger, M.D., Michael Burg, M.D., Friedrich C. Luft, M.D., Wilfried Gwinner, M.D., and Hermann Haller, M.D.
Background Most renal transplants fail because of chronic allograftnephropathy or because the recipient dies, but no reliable factorpredicting long-term outcome has been identified. We testedwhether a renal arterial resistance index of less than 80 waspredictive of long-term allograft survival.
Methods The renal segmental arterial resistance index (the percentagereduction of the end-diastolic flow as compared with the systolicflow) was measured by Doppler ultrasonography in 601 patientsat least three months after transplantation between August 1997and November 1998. All patients were followed for three or moreyears. The combined end point was a decrease of 50 percent ormore in the creatinine clearance rate, allograft failure (indicatedby the need for dialysis), or death.
Results A total of 122 patients (20 percent) had a resistanceindex of 80 or higher. Eighty-four of these patients (69 percent)had a decrease of 50 percent or more in creatinine clearance,as compared with 56 of the 479 patients with a resistance indexof less than 80 (12 percent); 57 patients with a higher resistanceindex (47 percent) required dialysis, as compared with 43 patientswith a lower resistance index (9 percent); and 36 patients witha higher resistance index (30 percent) died, as compared with33 patients with a lower resistance index (7 percent) (P<0.001for all comparisons). A total of 107 patients with a higherresistance index (88 percent) reached the combined end point,as compared with 83 of those with a lower resistance index (17percent, P<0.001). The multivariate relative risk of graftloss among patients with a higher resistance index was 9.1 (95percent confidence interval, 6.6 to 12.7). Proteinuria (proteinexcretion, 1 g per day or more), symptomatic cytomegalovirusinfection, and a creatinine clearance rate of less than 30 mlper minute per 1.73 m2 of body-surface area after transplantationalso increased the risk.
Conclusions A renal arterial resistance index of 80 or highermeasured at least three months after transplantation is associatedwith poor subsequent allograft performance and death.
Source Information
From the Departments of Nephrology (J.R., S.E., S.S., M.H., A.S., U.E., M.B., W.G., H.H.) and Pathology (M.M.), Hannover Medical School, Hannover, Germany; and the Franz Volhard Clinic, HELIOS Klinikum-Berlin, Humboldt University of Berlin, Berlin, Germany (F.C.L.).
Address reprint requests to Dr. Radermacher at the Department of Nephrology, Medizinische Hochschule Hannover, P.O. Box 61 01 80, D-30625 Hannover, Germany, or at radermacher.joerg{at}mh-hannover.de.
Renal Arterial Resistance Index
Giraudeau B., Halimi J.-M., Jay S. J., Pape L., Offner G., Ehrich J. H.H., Radermacher J., Stuht S., Haller H.
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N Engl J Med 2003;
349:1573-1574, Oct 16, 2003.
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