Intraoperative Assessment of Kidney Allograft Perfusion by Laser-Assisted Indocyanine Green Fluorescence Videography

• Published in: Transplantation proceedings Vol. 42; no. 5; pp. 1526 - 1530
• Main Authors: Hoffmann, C, Compton, F, Schäfer, J.H, Steiner, U, Fuller, T.F, Schostak, M, Zidek, W, van der Giet, M, Westhoff, T.H
• Format: Journal Article
• Language: English
• Published: Amsterdam Elsevier Inc 01.06.2010; Elsevier
• Subjects: Adult; Aged; Biological and medical sciences; Cadaver; Female; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Green Fluorescent Proteins; Humans; Indocyanine Green; Intraoperative Period; Kidney Transplantation - methods; Male; Medical sciences; Middle Aged; Spectrometry, Fluorescence; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Tissue, organ and graft immunology; Transplantation, Homologous; Fluorescence; Intraoperative; Transplantation; Indocyanine green; Homotransplantation; Video recording; Kidney; Medicine; Treatment; Urinary system; Perfusion; Surgery; Laser; Graft
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2010.01.069

Abstract Background Kidney allograft function crucially depends on the quality of organ perfusion. Duplex sonography, however, frequently reveals hypoperfused segments that remained undetectable to visual inspection intraoperatively. To date, no imaging system supplementing the surgeon's experience has achieved clinical acceptance. The present work examines whether laser-assisted indocyanine green (ICG) fluorescence-videography can be used as a safe and sensitive technique for the intraoperative assessment of renal allograft perfusion. Methods Intraoperative assessment of organ perfusion by laser-assisted ICG fluorescence videography (IC-VIEW) was performed in 10 consecutive de novo renal transplantations. The IC-VIEW system allows the visualization of graft perfusion by the fluorescein dye ICG that emits infrared light after exposure to laser light. Results Perfusion measurements were successful in all 10 transplant recipients. Fluorescence videography produced brilliant, sharply contrasted images of the organs, allowing the detection of even small perfusion deficits. Remarkably, this technique detected 1 large perfusion defect that had remained imperceptible to visual inspection. Repositioning of the graft led to a homogeneous overall perfusion. There were no complications with the ICG injection or the imaging device. Conclusion Laser-assisted ICG fluorescence videography is a feasible and safe technique for the intraoperative assessment of renal allograft perfusion.