ESPN 53rd Annual Meeting

ESPN 2021


 
Circulation and hemodynamics in living donation of kidney transplantation in children - the child-kitc study: magnetic resonance - arterial spin labeling perfusion imaging in pediatric ktx
E.L. Stille 1 M. Voet 1 E.A.M. Cornelissen 1 P.P. Poyck 1 M.F.P. van der Jagt 1 A. Nusmeier 1 W. Klein 1 J. Lemson 1 J.I. Malagon 1 J.J. F├╝tterer 1

1- RADBOUD UNIVERSITY MEDICAL CENTER
 
Introduction:

In pediatric kidney transplantation, adequate perfusion of adult-sized grafts demands significant hemodynamic changes in small recipients. Hypoperfusion can shorten graft survival by loss of kidney mass and function, especially in donor-recipient size mismatch. In order to adequately perfuse the transplanted adult-sized kidney, young recipients are hypothesized to develop a supraphysiological hemodynamic state. Our primary objective is to enhance knowledge and insight in hemodynamic responses after pediatric kidney transplantation with a living, adult donor. By comparing Magnetic Resonance – Arterial Spin Labeling (MR-ASL) with transabdominal and intra-operative ultrasound (US), our secondary goal is investigating the reliability of non-invasive techniques in monitoring donor kidney perfusion after transplantation.

Material and methods:

Twenty children (including donors) with a maximum age of 15 and a maximum weight of 40kg will be included in this prospective clinical pilot study with 12 months of follow-up. Peri-operative hemodynamics are monitored closely, including cardiac output measurements. We measured volume of the kidney graft (MR), whole organ kidney perfusion (MR-ASL) and afferent blood flow (US and MR) before, during and 6 months after transplantation. We present the first three patients with complete series of imaging in follow up.

Results:

MR-ASL perfusion imaging yields good quality images and reproducible perfusion values. Kidney graft volumetrics and perfusion showed a decrease after transplant, and a subsequent compensatory increase at 6 months. Afferent flow measurements comparing US and MR are corresponding, and in line with our hypotheses.

 

Mean graft volume (cm3)

Mean graft perfusion (ml/min)

1. Pre-transplant

306

407

2. Post-transplant

202

(↓34%)

161

(↓60%)

3. FU 6 months

226

(↑12%)

233

(↑45%)

Conclusions:

In pediatric kidney transplantation with an adult living donor, graft volume and perfusion decreased considerably after transplantation and recovered partially after 6 months. Complementing current monitoring techniques, MR-ASL proves to be a feasible non-invasive peri-operative imaging technique, yielding good quality images and reproducible perfusion values.