Ulrich Rother1, Andreas L H Gerken2, Ioannis Karampinis2, Madeline Klumpp1, Susanne Regus1, Alexander Meyer1, Hendrik Apel3, Bernhard K Krämer4, Karl Hilgers5, Werner Lang1, Kai Nowak2. 1. Department of Vascular Surgery, University of Erlangen, Erlangen, Germany. 2. Department of Surgery, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany. 3. Department of Urology, University of Erlangen, Erlangen, Germany. 4. Department of Medicine V, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany. 5. Department of Nephrology, University of Erlangen, Erlangen, Germany.
Abstract
OBJECTIVE: Sufficient blood supply is a crucial factor determining postoperative allograft function in kidney transplantation. Therefore, besides the surgeon's individual impression, a method for evaluating the quality of the organ's microperfusion is required. Laser fluorescence angiography with indocyanine green (ICG) is an emerging tool for this purpose. However, no reproducible quantification of ICG fluorescence has been performed in transplantation so far. METHODS: This retrospective two-center study was designed to evaluate the dosing of ICG for intraoperative laser fluorescence angiography in kidney transplantation. The Spy Elite® system (NOVADAQ, Canada) was employed for quantitative assessment of allograft microperfusion. ICG was administered systemically 5 minutes after reperfusion applying doses between 0.25 and 0.01 mg ICG per kg body weight. Quantitative assessment was performed with the implemented SPY-Q Software. RESULTS: A total of 57 kidney recipients were included in two centers. The generated curves showing ICG IN and EgR were not evaluable due to oversensing when doses exceeded 0.02 mg per kg body weight. CONCLUSIONS: Fluorescence angiography with ICG is an emerging tool for the intraoperative quality control and evaluation of microperfusion in kidney transplantation. A dose of 0.02 mg ICG per kg body weight is recommended to ensure the quantitative assessment with SPY-Q.
OBJECTIVE: Sufficient blood supply is a crucial factor determining postoperative allograft function in kidney transplantation. Therefore, besides the surgeon's individual impression, a method for evaluating the quality of the organ's microperfusion is required. Laser fluorescence angiography with indocyanine green (ICG) is an emerging tool for this purpose. However, no reproducible quantification of ICG fluorescence has been performed in transplantation so far. METHODS: This retrospective two-center study was designed to evaluate the dosing of ICG for intraoperative laser fluorescence angiography in kidney transplantation. The Spy Elite® system (NOVADAQ, Canada) was employed for quantitative assessment of allograft microperfusion. ICG was administered systemically 5 minutes after reperfusion applying doses between 0.25 and 0.01 mg ICG per kg body weight. Quantitative assessment was performed with the implemented SPY-Q Software. RESULTS: A total of 57 kidney recipients were included in two centers. The generated curves showing ICG IN and EgR were not evaluable due to oversensing when doses exceeded 0.02 mg per kg body weight. CONCLUSIONS: Fluorescence angiography with ICG is an emerging tool for the intraoperative quality control and evaluation of microperfusion in kidney transplantation. A dose of 0.02 mg ICG per kg body weight is recommended to ensure the quantitative assessment with SPY-Q.
Authors: Andreas L H Gerken; Kai Nowak; Alexander Meyer; Christel Weiss; Bernd Krüger; Nina Nawroth; Ioannis Karampinis; Katharina Heller; Hendrik Apel; Christoph Reissfelder; Kay Schwenke; Michael Keese; Werner Lang; Ulrich Rother Journal: Ann Surg Date: 2020-12-30 Impact factor: 13.787
Authors: Ulrich Rother; Helena Müller-Mohnssen; Werner Lang; Ingo Ludolph; Andreas Arkudas; Raymund E Horch; Susanne Regus; Alexander Meyer Journal: Int Wound J Date: 2019-10-30 Impact factor: 3.315