CT 鈣化評分與超音波阻力指數：強化腎移植後功能恢復之預測

李宗融、林國仁^1,2、林志德^1,2、潘伯諺¹、陳思遠¹、楊聿寬¹、王敘涵^1,2

林口長庚紀念醫院 教學部 一般科；¹林口長庚紀念醫院 外科部 泌尿科；

²長庚大學 醫學院

Integrating CT Calcification and Doppler PI for Enhanced Prediction of Renal Graft Recovery after Kidney Transplantation

Tsung-Jung Lee, Kuo-Jen Lin^1,2, Chih-Te Lin^1,2, Pai-Yen Pan¹, Sy-Yuan Chen¹, Yu-Kuan Yang¹, Hsu-Han Wang^1,2

Department of General Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan

¹Department of Urology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan

²School of Medicine, Chang Gung University, Taoyuan, Taiwan

Purpose: To evaluate the predictive value of preoperative iliac artery calcification (measured by CT) and postoperative vascular imaging (Doppler ultrasound and Nuclear Medicine) on intraoperative hemodynamic stability and the occurrence of Delayed Graft Function (DGF) in kidney transplant recipients.

Materials and Methods: We retrospectively analyzed 40 kidney transplant cases (stratified by deceased vs. living donors). Preoperative CT was used to assess iliac artery calcification (circumference and length). Intraoperative mean arterial pressure (MAP) was monitored. Postoperative assessment included Pulsatility Index (PI) of graft vessels and Nuclear Medicine (MAG-3 clearance/OIH). Statistical analysis was performed using SPSS 2024, utilizing Pearson correlation to assess associations between imaging parameters and clinical outcomes (Cr levels and dialysis requirements).

Results: (1) Preoperative iliac circumference calcification was significantly correlated with a longer duration and higher percentage of intraoperative MAP < 65 mmHg (p < 0.05). (2) Calcification length was positively associated with an increased risk of DGF and prolonged dialysis dependency. (3) Higher postoperative PI values (Artery and Vein) were significantly correlated with higher 1-week Cr levels and a greater magnitude of Cr reduction at 1 and 3 months (p < 0.05). (4) Lower MAG-3 clearance and OIH values in nuclear scans were strong predictors of 1-week Cr elevation and the need for dialysis beyond 7 days.

Conclusions: Preoperative vascular calcification not only increases technical complexity but also predisposes patients to intraoperative hypotension and subsequent DGF. Postoperative Doppler PI and nuclear imaging serve as reliable early indicators for predicting graft functional recovery and the necessity of post-transplant dialysis.