Ellebrecht David Benjamin, Warns Tilmann, Bürk Conny Georg, Thomaschewski Michael, Keck Tobias, Bausch Dirk
Klinik für Chirurgie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Deutschland.
Allgemein- und Viszeralchirurgie, AGAPLESION EV. KLINIKUM SCHAUMBURG, Deutschland.
Zentralbl Chir. 2020 Feb;145(1):57-63. doi: 10.1055/a-0998-4424. Epub 2019 Sep 26.
Postoperative delayed graft function (DGF) after kidney transplantation is a risk factor for kidney failure and reduced kidney allograft survival after transplantation. The aim of this study was to measure the quantitative perfusion of kidney transplants during kidney transplantation and to investigate whether differences in perfusion predict the development of DGF. Over a period of one year, intraoperative quantitative ICG perfusion measurements were performed with the IC-View camera (Pulsion) in 36 patients for whom informed consent for ICG perfusion measurement had been obtained. The groups were divided into donation after brain death and living donors and into the occurrence or absence of a DGF. An area with sufficient and low ICG perfusion was determined intraoperatively. The maximum perfusion was significantly decreased in the DGF group compared to living donors in areas with sufficient ICG perfusion and the slope of perfusion in these areas was documented. In addition, the maximum perfusion ratio was investigated. Evaluation was carried out by IC-Calc software (Pulsion). A total of 36 patients were included in this study. DGF occurred in 10 of the patients. No DGF was found in the group of living donors. The maximum perfusion and the slope of perfusion in the defined areas were fewer, but not significant in the group with BDB donor. The less perfused areas showed significant differences between DGF and living donors in maximum perfusion, absolute slope of perfusion and ratio to the standard area. A difference between BDB donor without DGF and the DGF group could not be predicted. This study shows that quantitative perfusion of kidney transplants can be evaluated safely during kidney transplantation. DGF being defined as one or more dialyses after kidney transplantation can only be detected postoperatively, however, it may be predicted intraoperatively.
肾移植术后移植肾功能延迟恢复（DGF）是肾衰竭的危险因素，会降低移植后肾移植的存活率。本研究的目的是在肾移植过程中测量肾移植的定量灌注，并研究灌注差异是否可预测DGF的发生。在一年的时间里，使用IC-View相机（Pulsion）对36例已获得ICG灌注测量知情同意书的患者进行了术中ICG定量灌注测量。这些组被分为脑死亡后供体和活体供体，以及是否发生DGF。术中确定了ICG灌注充足和较低的区域。与活体供体相比，DGF组在ICG灌注充足区域的最大灌注显著降低，并记录了这些区域的灌注斜率。此外，还研究了最大灌注率。通过IC-Calc软件（Pulsion）进行评估。本研究共纳入36例患者。其中10例患者发生了DGF。在活体供体组中未发现DGF。在脑死亡后供体组中，定义区域的最大灌注和灌注斜率较少，但无显著差异。灌注较少的区域在最大灌注、灌注绝对斜率和与标准区域的比值方面，DGF组和活体供体组之间存在显著差异。无法预测无脑死亡后供体DGF组与DGF组之间的差异。本研究表明，在肾移植过程中可以安全地评估肾移植的定量灌注。DGF被定义为肾移植后进行一次或多次透析，只能在术后检测到，然而，也可能在术中预测到。
