Ietto Giuseppe, Iori Valentina, Inversini Davide, Parise Cristiano, Zani Elia, Iovino Domenico, Tozzi Matteo, Gasperina Daniela Dalla, Carcano Giulio, Workgroup Icg
From the Department of Surgery, Division of Transplantation, SUNY Upstate Medical University, Syracuse, New York, USA.
Exp Clin Transplant. 2023 Feb;21(2):110-115. doi: 10.6002/ect.2022.0339.
Criteria for donation have been expanded to meet the great demand for organ transplant, resulting in different tools and classifications to help physicians to better assess the quality of the transplanted kidney. In this study, we evaluated the use of indocyanine green angiography as an additional tool to evaluate the renal microcirculation and the quality of the potential kidney graft.
All kidneys from extended criteria donors or donors after cardiac death available for transplant underwent indocyanine green angiog-raphy before implantation and after reconditioning, when hypothermic perfusion was required. We performed fluorescent angiography with a 10-mm-view laparoscope connected to a high-definition camera system while a solution of indocyanine green and Celsior was injected into the renal artery. We compared fluorescence intensities with postoperative graft function and then analyzed increases in fluorescence intensity before and after hypothermic machine perfusion treatment.
In transplanted kidneys preserved in traditional cold storage, we found a statistically significant difference in fluorescence intensity values between groups with early graft function and delayed graft function. Fluorescence intensity increased significantly in all perfused kidneys after hypothermic machine perfusion treatment, indicating that intensity was directly proportional to improved renal microcirculation. Among 21 kidneys retrieved for transplant that adhered to the inclusion criteria, 11 were examined histopathologically, with a Karpinski score ranging from 2 to 7. The kidney that scored 7 was immediately discarded. Five underwent hypothermic pulsatile perfusion since they came from donors after cardiac death. Fluorescence intensity increased significantly in all perfused kidneys (4/5 were closest to doubling). Histopathological evaluations and Karpinski scores of the grafts indicated that all 5 were considered suitable for transplant.
Indocyanine green angiography can be used in the future as an additional useful tool to help physicians to assess graft quality before implantation.
捐赠标准已扩大，以满足器官移植的巨大需求，从而产生了不同的工具和分类方法，以帮助医生更好地评估移植肾的质量。在本研究中，我们评估了吲哚菁绿血管造影作为一种辅助工具，用于评估肾微循环和潜在肾移植供体的质量。
所有符合扩大标准的供体或心脏死亡后可供移植的供体肾脏，在植入前以及需要进行低温灌注的复温处理后，均接受吲哚菁绿血管造影检查。我们使用连接到高清摄像系统的10毫米视野腹腔镜进行荧光血管造影，同时将吲哚菁绿和Celsior溶液注入肾动脉。我们将荧光强度与术后移植肾功能进行比较，然后分析低温机器灌注处理前后荧光强度的增加情况。
在传统冷保存的移植肾中，我们发现早期移植肾功能组和延迟移植肾功能组之间的荧光强度值存在统计学显著差异。低温机器灌注处理后，所有灌注肾脏的荧光强度均显著增加，表明强度与改善的肾微循环直接相关。在符合纳入标准的21个供移植肾中，11个进行了组织病理学检查，卡平斯基评分范围为2至7分。评分为7分的肾脏立即被丢弃。5个来自心脏死亡供体的肾脏进行了低温搏动灌注。所有灌注肾脏的荧光强度均显著增加（4/5最接近翻倍）。移植物的组织病理学评估和卡平斯基评分表明，所有5个均被认为适合移植。
吲哚菁绿血管造影未来可作为一种额外的有用工具，帮助医生在植入前评估移植物质量。
