Multimodal assessment of early kidney allograft complications: Role of renal scintigraphy and laboratory biomarkers

Mykyta  Nechaiev

doi:10.31450/ukrjnd.2(90).2026.05

Mykyta Nechaiev State Non-Commercial Enterprise «National Children's Specialized Hospital «Okhmatdyt» Ministry of Health of Ukraine», Kyiv, Ukraine; Bogomolets National Medical University, Kyiv, Ukraine https://orcid.org/0000-0002-7345-5124

DOI: https://doi.org/10.31450/ukrjnd.2(90).2026.05

Keywords: kidney transplantation, postoperative complications, radioisotope renography, technetium tc 99m pentetate, perfusion index, functional index, glomerular filtration rate, delayed graft function, graft rejection.

Abstract

Early post-transplant complications remain a major challenge in kidney transplantation. It reveals an overlap of clinical manifestations and the limited specificity of routine laboratory markers may delay diagnosis. Functional renal scintigraphy provides a quantitative assessment of graft perfusion and function and may improve early detection of allograft dysfunction.

Objective. To evaluate the predictive value of scintigraphy, clinical and laboratory parameters for early post-transplant complications in kidney transplant recipients.

Methods. This single-center observational study included 65 kidney transplant recipients who underwent 99mTc-DTPA renal scintigraphy within 1-7 days after transplantation. Conventional laboratory markers (serum creatinine, blood urea, white blood cell count, erythrocyte sedimentation rate, platelet count) and scintigraphy indices, including perfusion index (PI), functional index (FI), and glomerular filtration rate (GFR), were analyzed. Patients were classified into stable graft function and complication groups. Statistical analysis included multivariable logistic regression, receiver operating characteristic (ROC) analysis, and principal component analysis (PCA).

Results. Thirty-three patients (50.8%) developed early post-transplant complications. Serum creatinine and platelet count were significantly higher in the complication group (p < 0.05). Multivariable regression identified serum creatinine, ESR, PI, FI and GFR as independent predictors of complications, with GFR demonstrating the strongest inverse association (p<0.0001). ROC analysis showed good diagnostic performance for PI (AUC 0.78-0.82), FI (AUC 0.75-0.80), and GFR (AUC 0.73-0.78). PCA demonstrated clustering of scintigraphy indices with markers of graft dysfunction and inflammation, supporting their complementary diagnostic value.

Conclusions. Functional renal parameters, particularly PI, FI and GFR, provide significant predictive value for early kidney allograft complications and outperform routine laboratory markers when used in isolation. An integrated approach combining laboratory and scintigraphy assessment may improve early risk stratification and guide timely clinical interventions in the post-transplant period.