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

Abstract

Kidney transplantation (KT) has become the treatment of choice for paediatric end-stage kidney disease. 1 Nevertheless, in comparison to adults, the small calibre of the vessels and the common size-mismatch between donors and recipients can predispose to vascular complications including allograft thrombosis. The latter may affect up to 10% of KTs and account for 35% of allograft losses in the first year. 2 Similar considerations might be made when dealing with liver transplantation (LT). Even in this case, early vascular complications may affect up to 25% of the grafts. 3 Therefore, prompt recognition and treatment are clearly essential for the preservation of the allograft.Vascular complications have no specific clinical or biochemical signs allowing for early diagnosis. Doppler-ultrasonography (DUS) and scintigraphy, for KT, are reliable tools to assess allograft perfusion, 4 but do not allow continuous monitoring of the allograft and can miss early diagnosis, even if performed with a strict schedule in early follow-up. 5 Transcutaneous near-infrared spectroscopy (NIRS) allows for non-invasive, real-time, continuous monitoring of regional oxygenation of the hemoglobin (rSrO2), which is an indirect measure of the blood flow and the metabolic state, of tissue placed deeper beyond the skin. Several clinical studies have tested the use of NIRS for monitoring cerebral and somatic perfusion in intensive care units 6 and

Intra-Abdominal Hypertension and Compartment Syndrome after Pediatric Liver Transplantation: Incidence, Risk Factors and Outcome

“…However, we could not find any association between changes in microcirculation (including NIRS) and the presence of IAH or ACS. This is in contrast to other studies outside the pLT setting [ 42 , 43 ] and the results of our own unpublished studies for patients who had not undergone pLT. In pLT, this could be explained by the extraordinary situation of a denervated liver graft, in combination with hyperdynamic circulation, due to cirrhosis before pLT, leading to an increased total liver blood flow after pLT [ 44 ].…”

Abdominal Organ Transplantation: Noteworthy Literature in 2021

“…A systematic review of the literature by Ghidini and colleagues identified 5 pertinent articles: 3 studies on kidney allografts and 2 on liver grafts for a total of 55 pediatric patients and 121 adults. 52 For the kidney allografts, NIRS measurements were significantly related to serum creatinine, estimated-glomerular filtration rate, urinary neutrophil gelatinase-associated lipocalin, serum lactate, resistive index assessed by Doppler-ultrasonography, and systolic blood pressure. For the liver allografts, NIRS showed a significant decrease in liver regional oxygenation before vascular complications occurred.…”

Use of near infrared spectroscopy for hemodynamic monitoring in pediatrics

“…A 2021 systematic review 36 found that oxygen saturation determined by NIRS may also be useful in liver and kidney transplantation. They analyzed 5 relevant publications: 3 studied graft perfusion in kidney transplantation and 2 referred to liver transplantation.…”