T1-mapping quantitative assessment of renal function and changes in serum cytokine levels after renal transplantation in children.
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BACKGROUND: Postoperative renal function assessment in pediatric kidney transplant recipients faces the challenge of insufficient sensitivity of traditional indicators. T1-mapping, a non-invasive imaging technique, can quantify changes in the microscopic structure of renal tissue. However, its application in the pediatric population and its relationship with serum cytokines remain unclear. This study hypothesized that T1-mapping can quantitatively assess early renal microstructural damage in pediatric kidney transplant recipients and that T1 values correlate with the activation of immune-inflammatory responses (reflected by serum cytokine levels). It aimed to explore the value of T1-mapping in evaluating renal function and its mechanistic association with inflammatory responses. MATERIALS AND METHODS: A total of 31 pediatric kidney transplant recipients (observation group, Obs group) and 31 healthy children (control group, Ctrl group) were enrolled. In the Obs group, T1-mapping was performed at 1, 3, and 6 months post-transplantation to measure T1 values in the renal cortex, medulla, and whole kidney. Serum creatinine (SCr), glomerular filtration rate (GFR), and other renal function indicators were assessed, along with CD4+, CD8+ lymphocyte counts, and levels of cytokines such as interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α). Based on the 6-month postoperative prognosis, participants were divided into the good prognosis group (GPG, n = 20) and poor prognosis group (PPG, n = 11). RESULTS: The T1 values of the renal cortex, medulla, and whole kidney in the Obs group were significantly higher than those in the Ctrl group (P < 0.05). Specifically, the cortical T1 value in the PPG was (1820 ± 110) ms, significantly higher than that in the GPG (1650 ± 80) ms (P < 0.05). The SCr in the PPG was (220 ± 35) μmol/L, and the GFR was (22 ± 5) mL/min/1.73m2, both significantly worse than the GPG (85 ± 12 μmol/L, 78 ± 10 mL/min/1.73m2, P < 0.05). The CD4+/CD8+ ratio in the GPG (1.49 ± 0.21) was higher than that in the PPG (0.87 ± 0.15), while the CD8+ cell count (550 ± 60 × 106/L) in the GPG was lower than that in the PPG (780 ± 75 × 106/L, P < 0.05). Levels of IL-6 (28.8 ± 6.5 pg/mL) and TNF-α (45.5 ± 8.3 pg/mL) in the PPG were significantly higher than those in the GPG (12.5 ± 3.0 pg/mL, 18.2 ± 4.1 pg/mL, P < 0.05). CONCLUSION: T1-mapping technology can quantitatively assess changes in renal function following pediatric kidney transplantation, with increased T1 values closely associated with immune-inflammatory activation and renal function damage. Serum cytokine levels reflect the intensity of the inflammatory response, providing new evidence for postoperative monitoring and intervention.