In vivo visualization of early microcirculatory changes following ischemia/reperfusion injury in human kidney transplantation.
To determine whether microcirculatory changes following ischemia/reperfusion (I/R) may serve as predictors for subsequent graft dysfunction, we used noninvasive orthogonal polarization spectral (OPS) imaging to directly visualize and quantify cortical kidney microcirculation. In a total of 13 combined kidney/pancreas recipients, following reperfusion (5/30 min) microcirculatory parameters such as capillary diameter, functional capillary density (FCD) and red-blood-cell velocity (V(RBC)) of the renal graft were analyzed. From these parameters, a heterogeneity index (HI) and volumetric capillary blood flow (vCBF) were calculated. In addition, the extent of graft injury was determined by daily analysis of serum creatinine, blood urea nitrogen, C-reactive protein and systemic leukocyte count for 7 days post-transplant. At early reperfusion, a heterogeneous perfusion pattern with oscillating flow and scattered microvascular thrombosis of peritubular capillaries, resembling a 'no reflow', was observed. FCD was constant throughout the entire reperfusion period, whereas HI, capillary diameters, V(RBC) and vCBF increased. The latter showed a significant positive correlation with creatinine changes between days 1 and 3. So far our finding of a positive correlation of early microvascular changes (vCBF) and clinical parameters (creatinine) indicate a possible therapeutic implication of OPS imaging to predict early I/R-induced renal graft dysfunction.
Schmitz
V
V
Department of General, Visceral and Transplantation Surgery, University Medicine Berlin, Charité, Campus Virchow, Berlin, Germany. volker.schmitz@charite.de
Schaser
K-D
KD
Olschewski
P
P
Neuhaus
P
P
Puhl
G
G
D000328:Adult; D051799:Delayed Graft Function / Q000175:diagnosis* / Q000503:physiopathology; D003952:Diagnostic Imaging / Q000379:methods*; D005260:Female; D006801:Humans; D016030:Kidney Transplantation; D008297:Male; D008833:Microcirculation; D008859:Microscopy, Polarization; D008875:Middle Aged; D011237:Predictive Value of Tests; D012044:Regression Analysis; D012079:Renal Circulation; D015427:Reperfusion Injury / Q000175:diagnosis* / Q000503:physiopathology; D014019:Tissue Donors