PIKA - Pathology and Imaging in Kidney Allografts

• Research type

  Research Study

• Full title

  Pathology and Imaging in Kidney Allografts

• IRAS ID

  248675

• Contact name

  Alastair, J Rankin

• Contact email

  alastair.rankin@nhs.net

• Sponsor organisation

  NHS Greater Glasgow and Clyde

• Duration of Study in the UK

  1 years, 10 months, 22 days

• Research summary

  Summary of Research
  A kidney transplant is the best way to treat someone with kidney failure. However, on average, transplants only last 10 – 15 years due to chronic rejection from the immune system and other causes of irreversible scarring. In order to maximize the life-span of a transplant, as soon as a transplanted kidney stops working as well as it should, it is often necessary to do a biopsy to determine what the problem is. Biopsy procedures have risks including bleeding, damage to the transplant and discomfort for the patient. Functional renal MRI is a new field of research, where modem imaging techniques can look at various measures in the kidney which are believed to represent important features such as blood flow, scarring and inflammation.

  In this study we will perform a renal MRI in 70 patients who have a renal transplant and who have been referred to undergo a biopsy of their transplant kidney. We will compare the findings on MRI with those seen on the biopsy specimen to see if renal MRI can non-invasively provide information regarding scarring and inflammation. In a sub-group of patients who go on to receive treatment for a condition called ‘rejection’ after their biopsy, we will offer those patients the opportunity to undergo a repeat MRI after their treatment. This is to see if MRI can detect changes in inflammation and scarring in response to treatment for rejection.

  It is hoped that in the near future renal MRI will improve the care of patients with kidney disease and renal transplants by being able to supplement information obtained on biopsies, limit the need for repeat biopsies to assess response to treatment and ultimately help in the development of new drugs to treat kidney disease.

  Summary of Results
  PIKA: PATHOLOGY & IMAGING IN KIDNEY ALLOGRAFTS RESULTS NEWSLETTER

  Who organised this study and when did it happen?
  This study was carried out by NHS Greater Glasgow & Clyde in partnership with the University of Glasgow. The study took place in Glasgow between February 2019 and May 2022.

  What was the reason for doing the study?
  For many people with kidney failure, a kidney transplant is the best way to treat their kidney failure. However, sometimes kidney transplants stop working sooner than we would like. There are many possible reasons why a kidney transplant might stop working, so often it is necessary to do a kidney biopsy to work out the cause. Kidney biopsies are safe procedures, but like any medical procedure, there are risks involved. In this study we aimed to see if a new type of MRI scan could provide some of the same information as a kidney biopsy to help us better diagnose, understand and treat patients whose kidney transplants are not working as well as they should.

  What was involved in this study?
  This study included people who had a kidney transplant and needed to undergo a biopsy of their kidney transplant. Participants in the study underwent a new type of research MRI scan within one week of their scheduled biopsy. We then compared the biopsy results with the MRI results to see if the MRI scan was able to provide some of the same information as the biopsy.

  What did the study find?
  The study had to be stopped early due to the COVID-19 pandemic. We had planned to recruit 70 people but the study was closed after 29 people had agreed to take part (of whom 20 had complete information available).

  The main question being studied was if the new MRI technique could detect kidney scarring. In this small study, there was no association between scarring on kidney biopsy and findings on the MRI scan. Similarly, the MRI scan was not able to reliably detect inflammation that was present on the kidney biopsy. This suggests that the new MRI technique is not able to replace a kidney biopsy when someone’s kidney transplant function is not as good as it should be.

  When we compared people whose transplant stopped working versus those whose transplant continued to function, one of the MRI measurements called “T1” was significantly different between the 2 groups. Further studies are needed to see if “T1” measurements on MRI can be used to help predict if a transplant is going to stop working or not.

  What do these results mean?
  This study ended up including fewer people than planned. Consequently, the results are less reliable. However, from the available information this study suggests that MRI is NOT able to detect scarring or inflammation that can be seen on a kidney biopsy. Some MRI measurements may be useful in helping to predict if a kidney transplant is going to continue working in the future or not but more research studies are needed to confirm this.

  Would you like more information?
  If you would like more information about this study please contact Dr Alastair Rankin who is one of the researchers:

  • PIKA Study Phone: 07784 860 621
  • Email: alastair.rankin2@nhs.scot

• REC name

  East Midlands - Leicester Central Research Ethics Committee

• REC reference

  18/EM/0305

• Date of REC Opinion

  31 Oct 2018

• REC opinion

  Further Information Favourable Opinion