NIRS-based monitoring of kidney graft perfusion

Abstract

Introduction Acute early vascular complications are rare, but serious complications after kidney transplantation. They often result in graft loss. For this reason, shortening the diagnostic process is crucial. Currently, it is standard procedure to monitor renal graft perfusion using Doppler ultrasound (DU). With respect to acute vascular complications, the main disadvantage of this type of examination is its periodicity. It would be of great benefit if graft blood perfusion could be monitored continuously during the early postoperative period. It appears evident that a well-designed near infrared spectroscopy (NIRS) monitoring system could prove very useful during the early post-transplantation period. Its role in the immediate diagnosis of vascular complications could result in a significant increase in graft salvage, thus improving the patient’s overall quality of life and lowering morbidity and mortality for renal graft recipients. The aim of this study was to design, construct and test such a monitoring system. Materials and methods We designed a rough NIRS-based system prototype and prepared a two-stage laboratory experiment based on a laboratory pig model. In the first stage, a total of 10 animals were used to verify and optimize the technical aspects and functionality of the prototype sensor by testing it on the animal kidneys in-vivo. As a result of these tests, a more specific prototype was designed. During the second stage, we prepared a unique laboratory model of a pig kidney autotransplantation and tested the system for long-term functionality on a group of 20 animals. Overall sensitivity and specificity were calculated, and a final prototype was prepared and completed with its own analytic software and chassis. Results We designed and constructed a NIRS-based system for kidney graft perfusion monitoring. The measurement system provided reliable performance and 100% sensitivity when detecting acute diminished blood perfusion of the transplanted kidneys in laboratory conditions. Conclusion The system appears to be a useful tool for diagnosing diminished blood perfusion of kidney transplants during the early postoperative period. However, further testing is still required. We believe that applying our method in current human transplantation medicine is feasible, and we are confident that our prototype is ready for human testing.

Transcutaneous near‐infrared spectroscopy (NIRS) for monitoring kidney and liver allograft perfusion

“…This might be considered too invasive, especially in the paediatric population, and might not be free from complications, even if no adverse events were reported during this procedure. 17 Further investigation should also relate rSrO2 to perfusion renal scintigraphy. Even if this is a point-evaluation of allograft perfusion, this is the most objective modality to assess both kidney vascularisation and function, also adding information about the early prognosis of the KT.…”

“…However, the main concern about this tool involves the need for a second intervention for its removal. This might be considered too invasive, especially in the paediatric population, and might not be free from complications, even if no adverse events were reported during this procedure 17 …”

Transplantation Surgery Department at IKEM Hospital, Prague, Czech Republic: Increasing Volume and Improving Outcomes Through Innovative Clinical Strategies and Technical Approaches

“…Efforts focus on experimental and clinical studies analyzing the uterine vasculature in preparation of uterus transplantation, 12,13 and the collection and examination of adipose tissue from living kidney donors utilized for research of atherosclerosis. 14 Preclinical research includes monitoring of kidney graft perfusion, 15 compromised wound healing in diabetes, 16 and tissue engineering of vascular grafts. 17…”

Near-infrared spectrometry: the future of renal graft perfusion monitoring?

“…22 The latest experimental work involving NIRS as RG perfusion monitoring by Maly et al demonstrated the feasibility and reproducibility with 100% sensitivity of NIRS for renal transplant perfusion monitoring in swine renal auto-transplantation experimental model when detecting a decreasing RG perfusion. 23…”