title: Assessment of renal graft function by perioperative monitoring of cortical microcirculation in kidney transplantation.
abstract: BACKGROUND
  We evaluated the significance of perioperative cortical microperfusion for graft function and long-term prognosis after renal allotransplantation. Thermodiffusion technology was clinically applied for the first time, after previous validation for perfusion monitoring of the renal cortex in pigs.
  
  
  METHODS
  A thermodiffusion probe was inserted into the renal cortex in 30 transplant recipients after graft reperfusion. Real-time measurements were recorded until the end of the operation. In 14 patients perfusion was measured daily until postoperative day 7. Microcirculation was correlated to serum creatinine level, scintigraphic findings, and long-term outcome.
  
  
  RESULTS
  In primary graft function, intraoperative perfusion was 85+/-7 mL/100 g per min compared with significantly lower values in cases with subsequent graft dysfunction. The best discrimination was defined for a level of 70 mL/100 g per min with a positive predictive value of 88% for detection of good graft function and 86% for nonfunction. Intraoperative perfusion was significantly different in patients with normal grafts, delayed function, and graft loss. Postoperatively, lower perfusion was found in acute tubular necrosis; a significant correlation could be noted between microcirculation and perfusion index measured by nuclear scanning (r=0.78, P<0.01). Living-related grafts were characterized by higher intraoperative perfusion and superior graft quality.
  
  
  CONCLUSIONS
  Thermodiffusion could be clinically applicable for the perioperative monitoring of renal graft perfusion. Intraoperative reduction of cortical microcirculation has a high predictive value with respect to detection of delayed renal function. Postoperatively, impaired renal microperfusion is associated with acute tubular necrosis. Living-related donor grafts show less microcirculatory alteration than cadaveric kidneys.
authors.affiliation: Department of Surgery, University of Heidelberg, Heidelberg, Germany. michaela.angelescu@t-online.de.
authors.forename: Michaela
authors.initials: M
authors.lastname: Angelescu
authors.forename: Thomas
authors.initials: T
authors.lastname: Kraus
authors.forename: Manfred
authors.initials: M
authors.lastname: Wiesel
authors.forename: Olaf
authors.initials: O
authors.lastname: Hergesell
authors.forename: Uwe
authors.initials: U
authors.lastname: Haberkorn
authors.forename: Ernst
authors.initials: E
authors.lastname: Klar
mesh_terms: D000293:Adolescent; D000328:Adult; D000375:Aging / Q000502:physiology; D002102:Cadaver; D002648:Child; D002675:Child, Preschool; D015925:Cryopreservation; D006439:Hemodynamics; D006801:Humans; D007668:Kidney / Q000503:physiopathology*; D007672:Kidney Cortex / Q000098:blood supply*; D016030:Kidney Transplantation; D019520:Living Donors; D008833:Microcirculation; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D008991:Monitoring, Physiologic; D011184:Postoperative Period; D012079:Renal Circulation; D015424:Reperfusion