Kidney transplantation is the only curative treatment for patients with end-stage renal disease. However, every transplant is unavoidably coupled to an ischemia reperfusion injury (IRI). In the kidney, IRI results in a sterile innate inflammatory response and can lead to acute kidney injury with subsequent delayed graft function, a form of acute post-transplant graft dysfunction. Among the most crucial cellular components in renal IRI are neutrophils and our group is currently targeting neutrophil transendothelial migration as a novel treatment strategy to improve the outcome after kidney transplantation.

Organ shortage is the cardinal problem in transplant medicine and use of marginal organs with pre-existing damage and extended ischemia time is becoming routine, reflecting decreasing numbers of donated organs. By extending the donor pol, new strategies to better protect grafts during the ischemic phase are urgently needed. One therapeutic option is to further improve the currently used preservation solutions and our group is specifically testing a modified Histidine-Tryptophan-Ketoglutarate (HTK) solution, named HTK-N.

Abstract

Kidney transplantation is the only curative treatment for patients with end-stage renal disease. Among the most critical determinants for short- as well as long-term graft survival is the primary ischemic insult during graft procurement and transplantation with the subsequent inflammatory damage during reperfusion. This ischemia reperfusion injury (IRI) is an inherent and unavoidable event following solid organ transplantation. In the kidney, IRI results in a sterile innate inflammatory response and can lead to acute kidney injury with subsequent delayed graft function, a form of acute post-transplant graft dysfunction, which correlates with IRI severity. Beyond short- term complications, delayed graft function is critically linked to allograft immunogenicity, long term graft function and its severity predicts overall graft survival.

Abstract

In solid organ transplantation, delayed graft function (DGF) is associated with inferior long-term graft and recipient survival. Prediction and early detection of DGF remain challenging and therefore timely intervention is difficult to realize. Hyperspectral imaging (HSI) is a non-contact, non-ionizing real-time assessment tool delivering quantitative information on tissue composition and perfusion. HIS software provides color-coded pictures representing oxygen saturation (StO2), tissue perfusion (near infrared perfusion index, NIR), organ hemoglobin index (OHI) and tissue water index (TWI). In kidney transplantation, intraoperative HSI was able to predict DGF.

Abstract