Department of Surgery, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
Department of Surgery, RoMed Hospital Rosenheim, Rosenheim, Germany.
Ann Surg. 2022 Aug 1;276(2):391-397. doi: 10.1097/SLA.0000000000004529. Epub 2020 Dec 30.
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.
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.
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.
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.
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.
Clinicaltrials.gov: NCT-02775838.
本研究旨在展示定量吲哚菁绿（ICG）荧光血管造影术对短期术后结果、延迟移植物功能障碍（DGF）发生和长期移植物存活率的预测能力。
DGF 是肾移植后的一个相关问题；供体器官的充分微循环灌注对于术后器官功能至关重要。ICG 荧光血管造影术可作为术中微循环质量控制的手段。
本前瞻性诊断研究于 2015 年 11 月至 2018 年 10 月在德国的 2 个移植中心进行，纳入了 128 例连续肾移植患者。通过近红外荧光血管造影术用 ICG 对供体器官的微循环进行术中评估；使用软件进行定量分析。评估灌注参数（例如 ICG 摄取）与供者、受者、围手术期和术后特征之间的关系。
23 例（24%）来自已故供者的肾移植受者发生 DGF。ICG 摄取（P=0.0027）、供者年龄（P=0.0452）、受者年龄（P=0.0139）和受者体重指数（P=0.0017）与 DGF 相关。ICG 摄取与受者年龄呈显著相关（r=-0.27662，P=0.0016）、与冷缺血时间（r=-0.25204，P=0.0082）和热缺血时间（r=-0.19778，P=0.0283）、手术时间（r=-0.32208，P=0.0002）、术后第 1 天（r=+0.22674，P=0.0104）和第 7 天（r=+0.33189，P=0.0001）的 eGFR 呈负相关。ICG 摄取的截断值为 106.23 AU，其对 DGF 的预测具有敏感性 78.3%和特异性 80.8%（P<0.0001）。
ICG 荧光血管造影术可在肾移植过程中进行术中定量评估微循环灌注。参数 ICG 摄取反映了受者和手术特征，并且能够预测 DGF 的发生。
Clinicaltrials.gov：NCT-02775838。
