Hyperspectral Imaging (HSI) of Human Kidney Allografts

Objective: Aim of our study was to test a noninvasive HSI technique as an intraoperative real time assessment tool for deceased donor kidney quality and function in human kidney allotransplantation. Summary of Background Data: HSI is capable to deliver quantitative diagnostic information about tissue pathology, morphology, and composition, based on the spectral characteristics of the investigated tissue. Because tools for objective intraoperative graft viability and performance assessment are lacking, we applied this novel technique to human kidney transplantation. Methods: Hyperspectral images of distinct components of kidney allografts (parenchyma, ureter) were acquired 15 and 45 minutes after reperfusion and subsequently analyzed using specialized HSI acquisition software capable to compute oxygen saturation levels (StO2), near infrared perfusion indices (NIR), organ hemoglobin indices, and tissue water indices of explored tissues. Results: Seventeen kidney transplants were analyzed. Median recipient and donor age were 55 years. Cold ischemia time was 10.8 ± 4.1 hours and anastomosis time was 35 ± 7 minutes (mean ± standard deviation). Two patients (11.8%) developed delayed graft function (DGF). cold ischemia time was significantly longer (18.6 ± 1.6) in patients with DGF (P < 0.01). Kidneys with DGF furthermore displayed significant lower StO2 (P = 0.02) and NIR perfusion indices, 15 minutes after reperfusion (P < 0.01). Transplant ureters displayed a significant decrease of NIR perfusion with increased distance to the renal pelvis, identifying well and poor perfused segments. Conclusion: Intraoperative HSI is feasible and meaningful to predict DGF in renal allografts. Furthermore, it can be utilized for image guided surgery, providing information about tissue oxygenation, perfusion, hemoglobin concentration, and water concentration, hence allowing intraoperative viability assessment of the kidney parenchyma and the ureter.

[1]  F. Messner,et al.  Live Confocal Tissue Assessment With SYTO16/PI and WGA Staining Visualizes Acute Organ Damage and Predicts Delayed Graft Function in Kidney Transplantation. , 2019, Annals of surgery.

[2]  D. Seehofer,et al.  Hyperspectral Imaging (HSI) in anatomic left liver resection , 2019, International journal of surgery case reports.

[3]  Thomas Neumuth,et al.  Tissue classification of oncologic esophageal resectates based on hyperspectral data , 2019, International Journal of Computer Assisted Radiology and Surgery.

[4]  Thomas Neumuth,et al.  Evaluation of hyperspectral imaging (HSI) for the measurement of ischemic conditioning effects of the gastric conduit during esophagectomy , 2019, Surgical Endoscopy.

[5]  Jesmar Buttigieg,et al.  Early urological complications after kidney transplantation: An overview , 2018, World journal of transplantation.

[6]  E. J. Aslim,et al.  The Utility of Intraoperative Near Infrared Fluorescence (NIR) Imaging with Indocyanine Green (ICG) for the Assessment of Kidney Allograft Perfusion , 2018, Journal of transplantation.

[7]  Peer W Kämmerer,et al.  Hyperspectral imaging in perfusion and wound diagnostics – methods and algorithms for the determination of tissue parameters , 2018, Biomedizinische Technik. Biomedical engineering.

[8]  R. Mannon.  Delayed Graft Function: The AKI of Kidney Transplantation , 2018, Nephron.

[9]  Hagen Malberg,et al.  Oxygenation and perfusion monitoring with a hyperspectral camera system for chemical based tissue analysis of skin and organs , 2016, Physiological measurement.

[10]  M. Naesens.  Zero-Time Renal Transplant Biopsies: A Comprehensive Review , 2016, Transplantation.

[11]  D. Segev,et al.  Changes in Discard Rate After the Introduction of the Kidney Donor Profile Index (KDPI) , 2016, American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons.

[12]  G. Gambaro,et al.  Predictive model for delayed graft function based on easily available pre-renal transplant variables , 2015, Internal and Emergency Medicine.

[13]  L. Rostaing,et al.  A useful scoring system for the prediction and management of delayed graft function following kidney transplantation from cadaveric donors. , 2014, Kidney international.

[14]  D. Goldfarb.  A risk prediction model for delayed graft function in the current era of deceased donor renal transplantation. , 2011, The Journal of urology.

[15]  S. Herrell,et al.  Open renal biopsy: comorbidities and complications in a contemporary series , 2009, BJU international.

[16]  R. Formica,et al.  Association between delayed graft function and allograft and patient survival: a systematic review and meta-analysis. , 2008, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[17]  J. Wetzels,et al.  Long-term outcome of renal transplantation from older donors. , 2006, The New England journal of medicine.

[18]  B. Brenner,et al.  Early experience with dual kidney transplantation in adults using expanded donor criteria. Double Kidney Transplant Group (DKG). , 1999, Journal of the American Society of Nephrology : JASN.

[19]  W. Gregoir.  [THE SURGICAL TREATMENT OF CONGENITAL VESICO-URETERAL REFLUX]. , 1964, Acta chirurgica Belgica.

[20]  T. Neumuth,et al.  [Possibilities and perspectives of hyperspectral imaging in visceral surgery]. , 2019, Der Chirurg; Zeitschrift fur alle Gebiete der operativen Medizen.

[21]  Guolan Lu,et al.  Medical hyperspectral imaging: a review , 2014, Journal of biomedical optics.

[22]  C. Cardella,et al.  Delayed graft function and the risk for death with a functioning graft. , 2010, Journal of the American Society of Nephrology : JASN.

[23]  E. Ok,et al.  Is "zero-hour" biopsy of the transplanted kidney risky? , 2004, Transplantation proceedings.