Department of Visceral, Transplant-, Thoracic- and Vascular Surgery, Division of Hepatobiliary Surgery and Visceral Transplant Surgery, University Clinic Leipzig.
lnnovation Center Computer Assisted Surgery (ICCAS), University of Leipzig, Leipzig, Germany.
Ann Surg. 2022 Jul 1;276(1):e48-e55. doi: 10.1097/SLA.0000000000004429. Epub 2020 Nov 13.
Aim of our study was to test a noninvasive HSI technique as an intraoperative real time assessment tool for deceased donor kidney quality and function in human kidney allotransplantation.
HSI is capable to deliver quantitative diagnostic information about tissue pathology, morphology, and composition, based on the spectral characteristics of the investigated tissue. Because tools for objective intraoperative graft viability and performance assessment are lacking, we applied this novel technique to human kidney transplantation.
Hyperspectral images of distinct components of kidney allografts (parenchyma, ureter) were acquired 15 and 45 minutes after reperfusion and subsequently analyzed using specialized HSI acquisition software capable to compute oxygen saturation levels (StO2), near infrared perfusion indices (NIR), organ hemoglobin indices, and tissue water indices of explored tissues.
Seventeen kidney transplants were analyzed. Median recipient and donor age were 55 years. Cold ischemia time was 10.8 ± 4.1 hours and anastomosis time was 35 ± 7 minutes (mean ± standard deviation). Two patients (11.8%) developed delayed graft function (DGF). cold ischemia time was significantly longer (18.6 ± 1.6) in patients with DGF (P < 0.01). Kidneys with DGF furthermore displayed significant lower StO2 (P = 0.02) and NIR perfusion indices, 15 minutes after reperfusion (P < 0.01). Transplant ureters displayed a significant decrease of NIR perfusion with increased distance to the renal pelvis, identifying well and poor perfused segments.
Intraoperative HSI is feasible and meaningful to predict DGF in renal allografts. Furthermore, it can be utilized for image guided surgery, providing information about tissue oxygenation, perfusion, hemoglobin concentration, and water concentration, hence allowing intraoperative viability assessment of the kidney parenchyma and the ureter.
本研究旨在测试一种非侵入性高光谱成像（HSI）技术，作为人类肾移植中供体肾质量和功能的术中实时评估工具。
HSI 能够基于所研究组织的光谱特征，提供有关组织病理学、形态和组成的定量诊断信息。由于缺乏用于客观评估移植肾术中活力和功能的工具，我们将这项新技术应用于人类肾移植。
在再灌注后 15 分钟和 45 分钟，获取肾移植供体（实质、输尿管）不同成分的高光谱图像，并使用专门的 HSI 采集软件对其进行分析，该软件能够计算氧饱和度水平（StO2）、近红外灌注指数（NIR）、器官血红蛋白指数和所探索组织的组织水指数。
分析了 17 例肾移植。中位受体和供体年龄为 55 岁。冷缺血时间为 10.8±4.1 小时，吻合时间为 35±7 分钟（平均值±标准差）。两名患者（11.8%）发生延迟肾功能恢复（DGF）。DGF 患者的冷缺血时间显著更长（18.6±1.6）（P<0.01）。DGF 肾在再灌注后 15 分钟显示出显著较低的 StO2（P=0.02）和 NIR 灌注指数。移植输尿管的 NIR 灌注随着距离肾盂的增加而显著降低，可识别灌注良好和灌注不良的节段。
术中 HSI 是可行的，并且对预测肾移植中的 DGF 具有重要意义。此外，它可用于图像引导手术，提供有关组织氧合、灌注、血红蛋白浓度和水浓度的信息，从而允许对肾实质和输尿管的术中活力进行评估。
