Yeen, Boey Ching (2021) Value Of Baseline Post-transplant Mag3 Renal Scintigraphy In The Evaluation Of Graft Function. Masters thesis, Universiti Sains Malaysia.
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Abstract
Objective. Accurate assessment of graft function in the post-transplant period is crucial as it influences patient management and graft prognostication. However, traditionally used modalities such as serum creatinine, urine output and ultrasonography are hampered by various drawbacks. This study sought to determine whether baseline DRS performed within 72 hours post-transplant could accurately depict graft function. This study chose the occurrence of delayed graft function (DGF), which is defined as the requirement for dialysis within the first week post-transplant, as the primary clinical end-point of graft function. Graft function at 1- and 3-months post-transplant were used as secondary endpoints. Subjects and Methods. This retrospective study enrolled all renal transplant recipients who underwent baseline DRS using MAG3 within 72 hours post-transplant between 2017 and 2019 in Hospital Kuala Lumpur. Two qualitative parameters, renogram grade and tubular injury severity score (TISS) and a quantitative parameter, R20:3, were evaluated. Three other experienced observers independently analysed a random selection of scans to assess interobserver agreement. Clinical data was scrutinised to determine whether patients developed DGF, their corresponding risk factors and graft function at 1- and 3-months. Results. A total of 120 patients underwent DRS within 72 hours. Three patients were excluded due to loss of scan data and primary graft dysfunction. The remaining 117 patients were enrolled. The overall incidence of DGF was 16.2%, with a significantly higher incidence amongst cadaveric graft recipients (53.6%) compared to living graft recipients (4.5%). Renogram grade ≥ 2, TISS ≥ 4 and R20:3 > 1.31 significantly predicted DGF, p<0.05 with high AUC for R20:3 of 0.97. The cut-off value for R20:3 was 1.31 with a sensitivity of 94.7% and specificity of 92.8% for the prediction of DGF. Grafts with parameters above the cut-offs showed significantly worse GFR at 1- and 3- months post-transplant. Both renogram grade and R20:3 showed excellent interobserver correlation. After adjustment for various donor and recipient factors, longer cold ischaemic times significantly contributed to DGF. Conclusion. Baseline DRS was able to depict early graft function and prognosticate grafts at 1- and 3-months post-transplant. Renogram grade and R20:3, which exhibit excellent interobserver correlation, should be included in the reporting of post-transplant DRS. Due to the greater incidence of impaired graft function in cadaveric graft recipients, routine baseline DRS could provide added value in this population.
| Item Type: | Thesis (Masters) |
|---|---|
| Subjects: | R Medicine |
| Divisions: | Institut Perubatan & Pergigian Termaju (Advanced Medical & Dental Institute (AMDI)) > Thesis |
| Depositing User: | NOR HASHIMY BIN ABDULLAH |
| Date Deposited: | 05 May 2026 04:32 |
| Last Modified: | 05 May 2026 04:32 |
| URI: | http://eprints.usm.my/id/eprint/64077 |
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