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. 2024 Dec 10;18(1):sfae392.
doi: 10.1093/ckj/sfae392. eCollection 2025 Jan.

Cerebral blood flow following successful living kidney transplantation: the VINTAGE study

Shuzo Kobayashi  1 , Sumi Hidaka  1 , Kazunari Tanabe  2 ; VINTAGE Investigators
Collaborators, Affiliations

Cerebral blood flow following successful living kidney transplantation: the VINTAGE study

Shuzo Kobayashi et al. Clin Kidney J. .

Abstract

Background: Chronic kidney disease (CKD) is a significant risk factor for cerebrovascular disease. However, there is limited research on how successful living donor kidney transplantation (LDKT) affects cerebral blood flow (CBF). This study aims to comprehensively investigate how LDKT influences CBF across various brain levels and regions.

Methods: Data from 53 recipients between 2016 and 2020 were obtained from the VINTAGE study conducted at our hospital. CBF was measured by level and region using single-photon emission computed tomography (SPECT), according to the Talairach brain atlas. The primary endpoint was the mean difference in CBF before and 1-year post-LDKT. Subgroup analysis using traditional risk factors assessed the heterogeneity of the effect on CBF in the frontal lobe region.

Results: LDKT improved blood flow in the anterior cerebral artery and middle cerebral artery but had less impact on the posterior cerebral artery. The most consistent improvements were observed in the frontal lobe region {left frontal lobe: -0.12 [95% confidence interval (CI) -0.18 to -0.05], P < .001; right frontal lobe: -0.13 [95% CI -0.21 to -0.05], P = .001}. Subgroup analysis showed a consistent effect of LDKT on frontal lobe CBF improvement, with no qualitative interaction observed.

Conclusions: LDKT contributes to the normalization of CBF, with improvement in anterior circulation and frontal lobe blood flow. To clarify the clinical significance of KT's CBF-improving effect, future studies should investigate the relationship between specific cognitive impairments (e.g. short-term memory, visuospatial ability, executive function) and CBF in each perfusion region.

Keywords: cerebral blood flow; cognitive function; frontal lobe; kidney transplantation; single-photon emission computed tomography.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Graphical Abstract
Graphical Abstract
Figure 1:
Figure 1:
Overview of blood flow changes in cerebral arteries. A lower Z-score indicates higher CBF, whereas a higher Z-score indicates lower CBF.
Figure 2:
Figure 2:
Left-side mean CBF changes by level and region. Levels and areas follow the Talairach brain atlas. A negative mean difference indicates improvement in CBF, zero indicates no change and positive indicates deterioration. Light blue indicates areas that showed favourable effects and brown indicates areas that showed unfavourable effects.
Figure 3:
Figure 3:
Right-side mean CBF changes by level and region. Levels and areas follow the Talairach brain atlas. A negative mean difference indicates improvement in CBF, zero indicates no change and positive indicates deterioration. Light blue indicates areas that showed favourable effects and brown indicates areas that showed unfavourable effects.
Figure 4:
Figure 4:
Subgroup analyses of CBF changes in the frontal lobe. PKT: pre-emptive kidney transplantation; PAD: peripheral arterial disease; IHD: ischaemic heart disease. Obesity is defined as a body mass index ≥25 kg/m2 and anaemia is defined as haemoglobin levels <12.0 g/dl in women and <13.0 g/dl in men. This study was not designed to provide robust interval estimates for each stratum of subgroup factors. The 95% CI estimates for subgroup analysis are affected by the reduction in the number of cases and should be interpreted with caution.
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