The Utility of Intraoperative Near Infrared Fluorescence (NIR) Imaging with Indocyanine Green (ICG) for the Assessment of Kidney Allograft Perfusion

Abstract

Background Near infrared light (NIR) fluorescence imaging with indocyanine green (ICG) has been used in various aspects of surgery, such as in the assessment of vascular anastomosis, tissue perfusion, and the identification of lymph nodes. In this study we evaluated the utility of NIR/ICG fluorescence imaging in kidney transplantation. Materials and Methods NIR/ICG imaging was used to assess allograft perfusion in n=1 living donor (LDRT) and n=2 deceased donor (DDRT) renal transplantations, performed in February 2017. The allograft arterial and venous anastomoses were done end-to-side to the corresponding recipient external iliacs, and ureteroneocystostomies were performed for urinary reconstructions. After completion of vascular anastomosis, ICG was given as intravenous bolus at 0.3mg/kg, followed by visual assessment of tissue perfusion and vascular anastomoses at 1-minute interval using fluorescence imaging (KARL STORZ NIR/ICG System). Results Homogenous global fluorescence of the allograft and vascular anastomosis was observed in all 3 cases. Immediate postoperative perfusion studies showed patent inflow and outflow vessels and well perfused transplanted kidneys. Immediate graft function was observed in 2 recipients (1 LDRT and 1 DDRT). One session of haemodialysis was performed in 1 DDRT recipient, for high serum potassium in the immediate postoperative setting, who otherwise had good urine output and serially declining serum creatinine. Conclusions NIR/ICG fluorescence imaging can be useful in renal transplantation for the intraoperative assessment of allograft perfusion, especially in complex cases with multiple renal arteries and vascular reconstructions.

Quantitative intraoperative Messung der Gewebeperfusion von Nierentransplantaten mittels Indocyaningrün-Angiografie

“…Eine Neuanlage der Gefäßanastomosen war nicht in unserem Kollektiv notwendig. In diesem Zusammenhang stellt die Nierentransplantat-Perfusionsdarstellung mittels ICG eine nützliche intraoperative Untersuchungsmethode dar, um solche potenziellen Komplikationen rasch erkennen und therapieren zu können [16,18].…”

Indocyanine green fluorescence imaging to assess bowel perfusion during totally laparoscopic surgery for colon cancer

“…Intravenous use is reported to be very safe generally, and cases of vasovagal or allergic reactions such as anaphylactic shock, hypotension, tachycardia, dyspnea, or urticaria are extremely rare. These properties make ICG an ideal agent for the acquisition of high-quality images of both the circulatory and lymphatic systems [7][8][9]. The recently developed IGFI facilitates easy performance of intraoperative fluorescence angiography and has been used to evaluate the real-time perfusion of the resection margin during a laparoscopic surgery [18][19][20].…”

“…Indocyanine green fluorescence imaging (IGFI) is a real-time method to evaluate the organ perfusion, based on direct visualization of the fluorescence emitted by indocyanine green (ICG) under near-infrared (NIR) light after the intravenous injection [7]. This technique has been widely used in various branches of surgical medicine including plastic, cardiothoracic, hepatobiliary, and gastrointestinal surgeries [8,9].…”

Indocyanine green fluorescence imaging to assess bowel perfusion during totally laparoscopic surgery for colon cancer

“…Intravenous use is reported to be very safe generally, and cases of vasovagal or allergic reactions such as anaphylactic shock, hypotension, tachycardia, dyspnea, or urticaria are extremely rare. These properties make ICG an ideal agent for the acquisition of high-quality images of both the circulatory and lymphatic systems [7][8][9] .…”

“…Indocyanine green fluorescence imaging (IGFI) is a real-time method to evaluate the organ perfusion, based on direct visualization of the fluorescence emitted by indocyanine green (ICG) under nearinfrared (NIR) light after the intravenous injection [7] . This technique has been widely used in various branches of surgical medicine including plastic, cardiothoracic, hepatobiliary, and gastrointestinal surgeries [8][9] .…”