Background: Renal allograft fibrosis burden is a strong prognosticator for chronic damage and can only be accurately measured through transplant biopsy at present. We hypothesized that measuring allograft perfusion, which is highly associated with PTC number, could aid in fibrosis assessment noninvasively.Methods: Excluding 54 patients with acute allograft damage(allograft rejection and BK virus-nephropathy), 55 patients with chronic damages were analyzed. All patients underwent 3D-arterial spin labeling (ASL) in 3.0 Tesla clinical imager, which could quantify allograft cortical blood perfusion, before biopsy. 3D-ASL results were measured independently by a radiologist and a nephrologist. Inter-observer and intra-observer agreement were assessed using kappa test. Allograft fibrosis percentage was quantified by Aperio Digital Pathology Slide Scanner in Masson trichrome-stained slides. Correlation between ASL parameter with fibrosis percentage was calculated by Pearson correlation.Results: The selected patients include recurrent and/or de novo glomerulopathy,IF/TA damages,calcineurin inhibitor nephrotoxicity. There were excellent inter-analyst and inter-time-point agreement with the mean overall kappa equal to 0.931(95% confidence interval:0.915-0.948) and 0.931(95% confidence interval: 0.916-0.946). Renal allograft cortical perfusion as assessed by 3D-ASL is strongly negatively correlated with allograft fibrosis percentage (r=0.79, P=0.000). Renal allograft cortical perfusion decreased from 203.22±43.41 ml/100g/min in Banff ci0 (N=11, mean fibrosis 3.2%±0.68%) to 182.49±55.66 ml/100g/min in Banff ci (N=16, mean fibrosis 12.0%±5.6%) to 94.23±14.93 ml/100g/min in Banff c2 (N=9, mean fibrosis 35.9%±8.2%) to 62.14±40.27 ml/100g/min in Banff c3 (N=9, mean fibrosis 69.9%±14.8%) . The area under the curve for diagnosing interstitial fibrosis ≥ci1, ci2 and ci3 using optimal cutoff were 0.805, 0.969, 0.920 respectively with sensitivity ranging from 0.677 to 1.00 .Conclusion : Functional magnetic resonance imaging of 3D-ASL could be potentially used to noninvasively evaluate allograft fibrosis burden in chronic damage patients.

CITATION INFORMATION: Wen J., Wang W., Ni X., Yu Y., Chen J., Zhang L., Liu Z. Assessing Fibrosis Burden in Renal Allograft with Chronic Damage Using Functional Magnetic Resonance Imaging Am J Transplant. 2017;17 (suppl 3).

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