Kidney transplantion (КT) is the optimal form of replacement therapy and the only one radical treatment for terminal chronic renal failure. Completely eliminating the phenomenon of uremia, KT provides an optimal level of medical and social rehabilitation and a high quality of life of recipients, practically without differences from other people. The purpose of the study was to evaluate ultrasonic characteristics and dopplerographic indices of blood flow in the vessels of the transplanted kidney in patients with kidney transplant dysfunction in the late term after KT. Material and methods. The study is based on the results of ultrasound of renal transplants in 26 patients with KT dysfunction conducted during the period of 2015-2016. The average age of the recipients was 38.99 ± 2.32 (34.35-43.62). There were 14 (53.84%) men and 12 (46.16%) women among the recipients. A related KT was performed in 6 patients, in 20 cases it was cadaveric. In all patients the level of plasma creatinine was above normal values, fluctuating on average from 155 to 629 μmol / L, averaging 259.46 ± 35.33 μmol / l. The period of ultrasound performing in recipients of related kidney transplantation (RKT) averaged 4.1 ± 0.85 (2.39-5.81) years after KT, with cadaveric kidney transplantation (CKT) 9.59 ± 1.45 (6.7-12.48) years, respectively. The ultrasound was performed on a Toshiba Xario apparatus with using a convection multi-frequency sensor (frequency 3-5 MHz) and consisted of assessing the graft condition, transplant topometry, assessing the condition of the perirenal space, color Doppler ultrasound, spectral Doppler. Results and discussion. As a result of ultrasounding transplants in the assessment of KT in B-mode and topometry, the following results were obtained: thickness of the parenchyma was 17.35 ± 0.45 mm, cortex – 7.8 ± 0.28 mm. Cortico-medullar differentiation was determined in the overwhelming majority as a clear-cut in 73.01% of the examined patients, echogenicity of renal tissue was elevated in 23.1% of the patient. Parameters of vascular resistance at the main artery in patients at late term after KT in individuals with elevated levels of serum creatinine and severity of the speed difference, although differing from the reference values, did not reach statistical significance depending on the type of KT. We did not detect differences depending on cadaver or related KT between groups. Dynamics of linear velocity indices and indices of vascular resistance of renal vessels in patients with RKT and CKT at the level of segmental arteries of the upper segment also showed almost complete absence of statically significant differences. There was a general tendency to increase the parameters reflecting an increase in the resistance of the renal vessels. A study of renal blood flow in recipients with a decrease in the function of the transplant on levels of the serum creatinine of the interlobar arteries also showed the absence of significant changes in parameters reflecting an increase in resistance of the renal vessels, depending on the type of transplantation. The performed study of renal blood flow parameters did not reveal significant differences in patients with RKT and CKT and dysfunction of the graft in the late postoperative period. Conclusions. Color mapping and pulsed dopplerography are methods that most accurately reflect the state of the kidney transplant. They can be used for multiple monitoring of the state of the kidney transplant and hemodynamic changes both in the early postoperative period and in later periods. The obtained data make it possible to apply the results of the study for further comparative analysis of the parameters of renal blood flow in individuals after kidney transplantation, depending on the presence or absence of renal graft failure.
Keywords: vascular indices, late renal transplant dysfunction, renal blood flow
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