Quantitative Assessment of Intraoperative Laser Fluorescence Angiography With Indocyanine Green Predicts Early Graft Function After Kidney Transplantation

Abstract

Objective: This study was designed to demonstrate the predictive ability of quantitative indocyanine green (ICG) fluorescence angiography for the short-term postoperative outcome, the occurrence of delayed graft function (DGF), and long-term graft survival. Summary Background Data: DGF is a relevant problem after kidney transplantation; sufficient microperfusion of the allograft is crucial for postoperative organ function. Fluorescence angiography with ICG can serve as an intraoperative quality control of microperfusion. Methods: This prospective diagnostic study, conducted in 2 German transplantation centers from November 2015 to October 2018, included 128 consecutive kidney transplantations. Intraoperative assessment of the allograft microperfusion was performed by near-infrared fluorescence angiography with ICG; a software was used for quantitative analysis. The associations between perfusion parameters (eg, ICG Ingress) and donor, recipient, peri-procedural, and postoperative characteristics were evaluated. Results: DGF occurred in 23 (24%) kidney recipients from deceased donors. ICG Ingress (P = 0.0027), donor age (P = 0.0452), recipient age (P = 0.0139), and recipient body mass index (P = 0.0017) were associated with DGF. ICG Ingress correlated significantly with recipient age (r = −0.27662, P = 0.0016), cold and warm ischemia time (r = −0.25204, P = 0.0082; r = −0.19778, P = 0.0283), operating time (r = −0.32208, P = 0.0002), eGFR on postoperative days 1 (r =+0.22674, P = 0.0104) and 7 (r = +0.33189, P = 0.0001). The cutoff value for ICG Ingress was 106.23 AU with sensitivity of 78.3% and specificity of 80.8% (P < 0.0001) for the prediction of DGF. Conclusion: Fluorescence angiography with ICG allows intraoperative quantitative assessment of microperfusion during kidney transplantation. The parameter ICG Ingress reflects recipient and procedure characteristics and is able to predict the incidence of DGF.

A novel genomic model for predicting the likelihood of delayed graft function in DCD kidney transplantation

“…In view of the good performance of the five-mRNAbased risk score for DGF prediction, this model may provide necessary guidance for early posttransplant or even pretransplant decision-making in DCD KT. On the one hand, transcription analysis of 1-hour renal biopsy by microarray or qPCR may provide timely warning of the risk of DGF immediately after DCD KT, which could promote timely therapeutic or preventive interventions to minimize the impact of DGF on KT recipients, including the close monitoring strategy, the adjustment of immunosuppressive regimen, the optimization of volume management and the administration of thymoglobulin (26,32). Meanwhile, patients with lower DGF risk may benefit from a shorter intensive monitoring period, therefore resulting in shorter overall hospital stays and lower medical costs (32).…”

“…On the one hand, transcription analysis of 1-hour renal biopsy by microarray or qPCR may provide timely warning of the risk of DGF immediately after DCD KT, which could promote timely therapeutic or preventive interventions to minimize the impact of DGF on KT recipients, including the close monitoring strategy, the adjustment of immunosuppressive regimen, the optimization of volume management and the administration of thymoglobulin (26,32). Meanwhile, patients with lower DGF risk may benefit from a shorter intensive monitoring period, therefore resulting in shorter overall hospital stays and lower medical costs (32). However, it is worth noting that the timeliness of gene expression quantification is key to the utility of the genomic model in clinical practice, which relies on the further development of rapid nucleic acid quantification technology and the optimization of whole processes of gene detection, including specimen collection and preparation, nucleic acid quantification and results return (33).…”

A Review of Current and Emerging Trends in Donor Graft-Quality Assessment Techniques

“…Their findings indicated that the impairment of intraoperative microperfusion in the allograft cortex is a risk factor for the occurrence of DGF, and that ICG Ingress is an independent predictor of DGF. Further studies are warranted to analyse the effect of applying early therapeutic approaches to prevent DGF in kidney transplant recipients, thus improving long-term graft success [46]. The use of imaging techniques to diagnose post-renal transplant complications has been discussed extensively in recent reviews [47][48][49]; therefore, the present work will only examine a few of the most recent studies in this field.…”

Intraoperative use of indocyanine green fluorescence imaging in rectal cancer surgery: The state of the art

“…In brief, a bolus of ICG is injected into the patient intravenously, NIR light is then absorbed by ICG in the tissue, and the resulting fluorescence is a reflection of perfusion. After the introduction of ICG angiography in clinical practice in 1989 to evaluate choroidal circulation[ 14 ], fluorescence imaging technology has been used in hepatobiliary[ 15 , 16 ], gastric cancer[ 17 ], gynecologic cancer[ 18 ], breast cancer[ 19 ] and transplantation surgery[ 20 ]. Furthermore, many colorectal surgeons routinely use ICG imaging to assess bowel viability during colorectal anastomosis.…”