Indocyanine green fluorescence angiography during liver and pancreas transplantation: a tool to integrate perfusion statement’s evaluation

Panaro, Fabrizio; Benedetti, Enrico; Chambrun, Guillaume Pineton de; Habibeh, Hussein; Leon, Piera; Bouyabrine, Hassan; Herrero, Astrid; Navarro, Francis

doi:10.21037/hbsn.2017.07.02

Cited by 23 publications

(15 citation statements)

References 20 publications

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“…A first case report of duodenal perfusion assessment in pancreas transplantation by means of ICG fluorescence was published in 2014 (32). A recent study described the application of ICG fluorescence angiography during liver and pancreas transplantation in a larger series of patients (33). The detection of intraoperative perfusion defects allowed for real time modification of technical strategies.…”

Section: Discussionmentioning

confidence: 99%

Intraoperative reperfusion assessment of human pancreas allografts using hyperspectral imaging (HSI)

Sucher¹,

Scheuermann²,

Rademacher³

et al. 2022

Hepatobiliary Surg Nutr

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Background:The most common causes of early graft loss in pancreas transplantation are insufficient blood supply and leakage of the intestinal anastomosis. Therefore, it is critical to monitor graft perfusion and oxygenation during the early post-transplant period. The goal of our pilot study was to evaluate the utility of hyperspectral imaging (HSI) in monitoring the microcirculation of the graft and adequate perfusion of the intestinal anastomosis during pancreatic allotransplantation.Methods: We imaged pancreatic grafts and intestinal anastomosis in real-time in three consecutive, simultaneous pancreas-kidney transplantations using the TIVITA ® HSI system. Further, the intraoperative oxygen saturation (StO 2 ), tissue perfusion (near-infrared perfusion index, NIR), organ hemoglobin index (OHI), and tissue water index (TWI) were measured 15 minutes after reperfusion by HSI.Results: All pancreas grafts showed a high and homogeneous StO 2 (92.6%±10.45%). Intraoperative HSI analysis of the intestinal anastomosis displayed significant differences of StO 2 (graft duodenum 67.46%±5.60% vs. recipient jejunum: 75.93%±4.71%, P<0.001) and TWI {graft duodenum: 0.63±0.09 [I (Index)] vs. recipient jejunum: 0.72±0.09 [I], P<0.001}. NIR and OHI did not display remarkable differences (NIR duodenum: 0.68±0.06 [I] vs. NIR jejunum: 0.69±0.04 [I], P=0.747; OHI duodenum: 0.70±0.12 [I] vs. OHI jejunum: 0.68±0.13 [I], P=0.449). All 3 patients had an uneventful postoperative course with one displaying a Banff 1a rejection which was responsive to steroid treatment. Conclusions:Our study shows that contact-free HSI has potential utility as a novel tool for real-time monitoring of human pancreatic grafts after reperfusion, which could improve the outcome of pancreas transplantation. Further investigations are required to determine the predictive value of intraoperative HSI imaging.

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Section: Discussionmentioning

confidence: 99%

Intraoperative reperfusion assessment of human pancreas allografts using hyperspectral imaging (HSI)

Sucher¹,

Scheuermann²,

Rademacher³

et al. 2022

Hepatobiliary Surg Nutr

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“…In recent years, different near-infrared fluorescence camera systems have been developed for both open and minimally invasive surgery. The dye has no adverse effects, at the standard clinical dosage of 0.1–0.5 mg/mL/kg [31].…”

Section: Indocyanine Green Fluorescence Imagingmentioning

confidence: 99%

“…The use of ICG fluorescence imaging in liver transplant surgery aids in predicting AGR through the assessment of (1) bile duct vascularization and biliary anastomosis, (2) perfusion evaluation of the arterial and portal anastomotic sites, and (3) fluorescence intensity [31, 37]. The outcome of these studies highly encouraged the use of ICG imaging during liver transplantation, providing safe objectifiable perfusion information during organ transplantations and allowing real-time modification of surgical techniques, thereby reducing graft dysfunction [31, 37].…”

Section: Indocyanine Green Fluorescence Imagingmentioning

confidence: 99%

Intraoperative Imaging Techniques to Visualize Hepatic (Micro)Perfusion: An Overview

Shen

Milstein

et al. 2020

Eur Surg Res

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The microcirculation plays a crucial role in the distribution of perfusion to organs. Studies have shown that microcirculatory dysfunction is an independent predictor of morbidity and mortality. Hence, assessment of liver perfusion offers valuable information on the (patho)physiological state of the liver. The current review explores techniques in perfusion imaging that can be used intraoperatively. Available modalities include dynamic contrast-enhanced ultrasound, handheld vital microscopes, indocyanine green fluorescence angiography, and laser contrast speckle imaging. Dynamic contrast-enhanced ultrasound relays information on deep tissue perfusion and is a commonly used technique to assess tumor perfusion. Handheld vital microscopes provide direct visualization of the sinusoidal architectural structure of the liver, which is a unique feature of this technique. Intraoperative fluorescence imaging uses indocyanine green, a dye that is administered intravenously to visualize microvascular perfusion when excited using near-infrared light. Laser speckle contrast imaging produces non-contact large surface-based tissue perfusion imaging free from movement-or pressure-related artefacts. In this review, we discuss the intrinsic advantages and disadvantages of these techniques and their clinical and/or scientific applications.

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“…The applicability and potential advantages of ICG fluorescence during organ transplantation are limited and incompletely understood. In liver and pancreas transplantations, ICG is used to assess graft bile duct perfusion and the perfusion level of the duodenal graft stump for identifying perfusion defects that may be transected before anastomosis (12,13). Furthermore, fluorescence angiography with ICG allows intraoperative quantitative assessment of delayed graft function during kidney transplantation (14).…”

Section: Introductionmentioning

confidence: 99%

Intraoperative assessment of ureter perfusion after revascularization of transplanted kidneys using intravenous indocyanine green fluorescence imaging

et al. 2021

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Background: Kidney transplantation is the most valuable renal replacement therapy. One of the most common urologic complications following kidney transplantation is ureter anastomosis leakage, which leads to high morbidity along with kidney graft loss. We hypothesized that indocyanine green (ICG) fluorescence videography can assess ureter perfusion after revascularization of transplanted kidneys.Methods: We conducted a prospective cross-sectional study in end-stage renal disease patients who underwent deceased donor kidney transplantation at Ramathibodi Hospital from September 2019 to January 2020. The segments of transplanted ureters were categorized as having good or poor perfusion based on the percentage from ICG fluorescence videography images. Then the results from ICG fluorescence videography were compared with histopathology which is considered the gold standard.Results: Thirty-one sections of dissected ureters were evaluated from 10 patients. Compared with pathological diagnosis of ureteral ischemia, ICG videography had sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and positive likelihood ratio of 100%, 92.6%, 66.7%, 100%, and 14, respectively. Accuracy was 93.6%. The area under the curve of ICG fluorescence videography was 0.96. The average ureter length that maintained good perfusion was 14 cm from the ureteropelvic junction.Adverse events from ICG were not observed in this study. Conclusions:We conclude that ICG fluorescence videography is beneficial for detection of early ureteral ischemia in kidney transplantation patients, with negligible adverse events. However, further studies with larger numbers of patients are necessary to confirm our results and clinical outcomes regarding complication rates.

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Indocyanine green fluorescence angiography during liver and pancreas transplantation: a tool to integrate perfusion statement’s evaluation

Cited by 23 publications

References 20 publications

Intraoperative reperfusion assessment of human pancreas allografts using hyperspectral imaging (HSI)

Intraoperative reperfusion assessment of human pancreas allografts using hyperspectral imaging (HSI)

Intraoperative Imaging Techniques to Visualize Hepatic (Micro)Perfusion: An Overview

Intraoperative assessment of ureter perfusion after revascularization of transplanted kidneys using intravenous indocyanine green fluorescence imaging

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