Ureterovesical Anastomosis Complications in Kidney Transplantation: Definition, Risk Factor Analysis, and Prediction by Quantitative Fluorescence Angiography with Indocyanine Green

Abstract

Ureteral stenosis and urinary leakage are relevant problems after kidney transplantation. A standardized definition of ureterovesical anastomosis complications after kidney transplantation has not yet been established. This study was designed to demonstrate the predictive power of quantitative indocyanine green (ICG) fluorescence angiography. This bicentric historic cohort study, conducted between November 2015 and December 2019, included 196 kidney transplantations. The associations between quantitative perfusion parameters of near-infrared fluorescence angiography with ICG and the occurrence of different grades of ureterovesical anastomosis complications in the context of donor, recipient, periprocedural, and postoperative characteristics were evaluated. Post-transplant ureterovesical anastomosis complications occurred in 18%. Complications were defined and graded into three categories. They were associated with the time on dialysis (p = 0.0025), the type of donation (p = 0.0404), and the number of postoperative dialysis sessions (p = 0.0173). Median ICG ingress at the proximal ureteral third was 14.00 (5.00–33.00) AU in patients with and 23.50 (4.00–117.00) AU in patients without complications (p = 0.0001, cutoff: 16 AU, sensitivity 70%, specificity 70%, AUC = 0.725, p = 0.0011). The proposed definition and grading of post-transplant ureterovesical anastomosis complications is intended to enable valid comparisons between studies. ICG Fluorescence angiography allows intraoperative quantitative assessment of ureteral microperfusion during kidney transplantation and is able to predict the incidence of ureterovesical anastomosis complications. Registration number: NCT-02775838.

Bright, photostable, and long-circulating NIR-II nanoparticles for wholeprocess monitoring and evaluation of renal transplantation

“…Among them, the quality of a donor's kidney directly influences the outcome of the transplantation. Furthermore, the anastomosis of vascular and ureterovesical also affects the reperfusion and urine excretion of implanted kidneys, which play a significant role for a successful renal transplantation surgery (8,9). Therefore, real-time evaluation and monitoring the reperfusion and urine excretion of kidney before, during and after the kidney implant will benefit a lot for increasing the success rate of renal transplant surgery.…”

Bright, photostable and long-circulating NIR-II nanoparticles for whole-process monitoring and evaluation of renal transplantation

“…Among them, the quality of a donor kidney directly influences the outcome of the transplantation. Furthermore, renal revascularization and ureterovesical anastomosis also influence the reperfusion and urine excretion, respectively, playing a significant role in the success of renal transplantation surgery [ 8 , 9 ]. Hence, real-time evaluation and monitoring of kidney reperfusion and urine excretion before, during and after kidney implantation can greatly enhance the success rate of renal transplant surgery.…”