Living Renal Allograft Transplantation: Diffusion-weighted MR Imaging in Longitudinal Follow-up of the Donated and the Remaining Kidney

Purpose: To determine whether diffusion-weighted (DW) magnetic resonance (MR) imaging in living renal allograft donation allows monitoring of potential changes in the nontrans-planted remaining kidney of the donor because of unilateral nephrectomy and changes in the transplanted kidney before and after transplantation in donor and recipient, respectively, and whether DW MR parameters are correlated in the same kidney before and after transplantation. Materials and Methods: The study protocol was approved by the local ethics committee; written informed consent was obtained. Thirteen healthy kidney donors and their corresponding recipients prospectively underwent DW MR imaging (multiple b values) in donors before donation and in donors and recipients at day 8 and months 3 and 12 after donation. Total apparent diffusion coefficient (ADC(T)) values were determined; contribution of microcirculation was quantified in perfusion fraction (F-P). Longitudinal changes of diffusion parameters were compared (repeated-measures one-way analysis of variance with post hoc pairwise comparisons). Correlations were tested (linear regression). Results: ADC(T) values in nontransplanted kidney of donors increased from a preexplantation value of (188 +/- 9 [standard deviation]) to (202 +/- 11) x 10(5) mm(2)/ sec in medulla and from (199 +/- 11) to (210 +/- 13) x 10(5) mm(2)/ sec in cortex 1 week after donation (P < .004). Medullary, but not cortical, ADC(T) values stayed increased up to 1 year. ADC(T) values in allo-grafts in recipients were stable. Compared with values obtained before transplantation in donors, the corticomedullary difference was reduced in allografts (P < .03). Cortical ADC(T) values correlated with estimated glomerular filtration rate in recipients (R = 0.56, P < .001) but not donors. Cortical ADC(T) values in the same kidney before transplantation in donors correlated with those in recipients on day 8 after transplantation (R = 0.77, P =.006). F-P did not show significant changes. Conclusion: DW MR imaging depicts early adaptations in the remaining nontransplanted kidney of donors after nephrectomy. All diffusion parameters remained constant in allograft recipients after transplantation. This method has potential monitoring utility, although assessment of clinical relevance is needed. (C) RSNA, 2013