Intraoperative assessment of kidney allograft perfusion by laser-assisted indocyanine green fluorescence videography.
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.


CONCLUSIONS
Laser-assisted ICG fluorescence videography is a feasible and safe technique for the intraoperative assessment of renal allograft perfusion.
Hoffmann
C
C
Departments of Nephrology, and Urology, Charité - Campus Benjamin Franklin, Berlin, Germany.
Compton
F
F
Schäfer
J H
JH
Steiner
U
U
Fuller
T F
TF
Schostak
M
M
Zidek
W
W
van der Giet
M
M
Westhoff
T H
TH
D000328:Adult; D000368:Aged; D002102:Cadaver; D005260:Female; D049452:Green Fluorescent Proteins; D006801:Humans; D007208:Indocyanine Green; D007432:Intraoperative Period; D016030:Kidney Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D013050:Spectrometry, Fluorescence; D014184:Transplantation, Homologous
D049452:Green Fluorescent Proteins; D007208:Indocyanine Green