Deceased vs. living donor kidney transplantation in prediction of acute renal allograft rejection using Tc-99m DTPA renal scan

Objectives No data are available regarding different prognostic values of Tc-99m diethylenetriaminepentaacetic acid (DTPA) renal scan in kidney transplantation (KT) recipients according to two distinct donor types: deceased donor KT (DDKT) and living donor KT (LDKT). We evaluated whether the interpretation of Tc-99m DTPA renal scan should be different by the donor type in predicting acute renal allograft rejection (AR). Methods One hundred and seven KT recipients (61 DDKT and 46 LDKT) were included in this study. Tc-99m DTPA renal scan was performed 1 week after KT. AR was defined as pathological evidence of renal allograft rejection during the first 6 months of KT. Clinical factors and Tc-99m DTPA renal scan findings were compared between patients with and without AR. To further analyze the effect of the donor type, they were again compared within DDKT and LDKT recipients, respectively. Results AR occurred in 15 patients (7 DDKT and 8 LDKT recipients). Among all patients, time to peak uptake (TTP) of the cortex (TTP CX ) measured by Tc-99m DTPA renal scan was independently predictive of AR. Moreover, TTP KD (TTP of the whole transplanted kidney) and TTP CX were the only predictors of AR among DDKT recipients. The most accurate predictors were TTP CX and kidney area on renal scan for DDKT and LDKT, respectively. However, these parameters could not predict AR for the opposite donor type. Conclusions AR could be effectively predicted by Tc-99m DTPA renal scan obtained at 1 week post-KT. Different parameters should be applied according to the donor type in the prediction of AR.