Society For Pediatric Urology

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Real-time kidney graft perfusion monitoring using infrared imaging during pediatric kidney transplantation
Nicolas Fernandez, M.D., PhD1, Armando Lorenzo, M.D2, Michael Chua, M.D2, MArtin Koyle, M.D.2, Walid Farhat, M.D.2, Clyde Matava, M.D.2.
1Hospital Universitario San Ignacio Pontificia Universidad Javeriana, Bogota, Colombia, 2Hospital for SickKids, Toronto, ON, Canada.

Introduction: Ischemia times in kidney transplantation have shown to be predictive for future graft function. Preservation solutions and anticoagulation protocols have improved the management of pediatric kidney transplantation. Nonetheless, there is no current tool for intraoperative graft monitoring. The aim of our project is to present a novel technique for intraoperative real-time assessment of graft perfusion using a non-invasive infrared camera. Methods: Prospectively we included 10 pediatric patients. Surgical procedure followed our institutional protocol. Infrared imaging was captured at graft preparation, vascular anastomosis, unclamping and at 30 seconds, 1, 5 and 10 minutes after unclamping. Analyzed variables included type of transplant, ischemia and procedure times, type of anastomosis and results of doppler/ultrasound. Postoperative variables included creatinine levels during first 72 hours. Any complications were also recorded. Delta analysis was calculated to establish the variation of temperature after unclamping. Results: Average age at transplant was 9.9 years. Five cases were living donor transplants. Mean overall ischemia time was 395.6SD 64.4 minutes. Two patients had poor graft perfusion after unclamping. Of those, one had torsion of the arterial anastomosis and the other was a graft from a donor that required cardio-pulmonary resuscitation for 45 minutes. Thermal imaging showed a correlation of 0.318 between graft temperature change and creatinine decrease. Cut-off delta for temperature for good reperfusion was above 0.2 at 1 minute. Conclusion: Real-time infrared imaging shows to be a promising option for non-invasive graft perfusion monitoring. Initial results show good correlation between intraoperative temperature changes, graft perfusion, and postoperative graft function.

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