Background. Kidney transplantation (KT) has become the treatment of choice for paediatric end-stage kidney disease. Nevertheless, paediatric KT might be affected by vascular complications, without specific clinical or biochemical signs. Transcutaneous near-infrared spectroscopy (NIRS) allows non-invasive, real-time, continuous monitoring of regional oxygenation of the haemoglobin (rSrO2). The primary aims of the project is to investigate risk factors for vascular complications and to validate NIRS monitoring of the kidney allograft perfusion in paediatric population. Methods. A database included all the paediatric KTs from 2013 to 2021 in order to retrospectively investigate the influence of low body weight, vascular anomalies, and the operators’ fatigue on the outcomes of KTs. As to NIRS, a systematic search gathered the current evidence to highlight the controversies. Then, a prospective observational study enrolled children that underwent KT at our department from March 2021. The kidney allograft was monitored by transcutaneous NIRS for five days. NIRS readings were compared to clinical, biochemical, and instrumental parameters, including a renal perfusion scintigraphy performed at day five. Finally, an experimental study involving an animal model of renal ischemia was designed to investigate the temporal relationship between NIRS modification and the outbreak of arterial or venous ischemia. Results. The database included 130 paediatric KTs. Patients with a body weight inferior to 15 kg, allograft with vascular anomalies that required a complex bench surgery and transplantations performed during extraordinary working hours presented similar outcomes, in terms of early survival and rate of complications. The systematic review yielded only two studies dealing with the use of NIRS after paediatric KTs and included 53 patients. In our project, the transcutaneous NIRS monitoring was available for eight patients. Seven patients completed the monitoring, and the analysis showed a significant correlation with the modification of the serum creatinine. One patient experienced a graft venous thrombosis and the time-curve of NIRS readings was reported for the first time in the literature. A rat model of renal arterial and venous ischemia was designed, making transcutaneous NIRS monitoring feasible in a small animal model. Conclusions. The standardization of the management of paediatric KTs is crucial to decrease the risk of complications and to improve the outcomes. Despite a limited sample size, this project reports positive preliminary results about the use of transcutaneous NIRS monitoring after paediatric KTs. The rat model should clarify the modifications of NIRS readings in case of vascular complications.
TRANSCUTANEOUS NEAR INFRA-RED SPECTROSCOPY (NIRS) FOR MONITORING PAEDIATRIC RENAL ALLOGRAFT PERFUSION / Ghidini, Filippo. - (2024 Mar 26).
TRANSCUTANEOUS NEAR INFRA-RED SPECTROSCOPY (NIRS) FOR MONITORING PAEDIATRIC RENAL ALLOGRAFT PERFUSION
GHIDINI, FILIPPO
2024
Abstract
Background. Kidney transplantation (KT) has become the treatment of choice for paediatric end-stage kidney disease. Nevertheless, paediatric KT might be affected by vascular complications, without specific clinical or biochemical signs. Transcutaneous near-infrared spectroscopy (NIRS) allows non-invasive, real-time, continuous monitoring of regional oxygenation of the haemoglobin (rSrO2). The primary aims of the project is to investigate risk factors for vascular complications and to validate NIRS monitoring of the kidney allograft perfusion in paediatric population. Methods. A database included all the paediatric KTs from 2013 to 2021 in order to retrospectively investigate the influence of low body weight, vascular anomalies, and the operators’ fatigue on the outcomes of KTs. As to NIRS, a systematic search gathered the current evidence to highlight the controversies. Then, a prospective observational study enrolled children that underwent KT at our department from March 2021. The kidney allograft was monitored by transcutaneous NIRS for five days. NIRS readings were compared to clinical, biochemical, and instrumental parameters, including a renal perfusion scintigraphy performed at day five. Finally, an experimental study involving an animal model of renal ischemia was designed to investigate the temporal relationship between NIRS modification and the outbreak of arterial or venous ischemia. Results. The database included 130 paediatric KTs. Patients with a body weight inferior to 15 kg, allograft with vascular anomalies that required a complex bench surgery and transplantations performed during extraordinary working hours presented similar outcomes, in terms of early survival and rate of complications. The systematic review yielded only two studies dealing with the use of NIRS after paediatric KTs and included 53 patients. In our project, the transcutaneous NIRS monitoring was available for eight patients. Seven patients completed the monitoring, and the analysis showed a significant correlation with the modification of the serum creatinine. One patient experienced a graft venous thrombosis and the time-curve of NIRS readings was reported for the first time in the literature. A rat model of renal arterial and venous ischemia was designed, making transcutaneous NIRS monitoring feasible in a small animal model. Conclusions. The standardization of the management of paediatric KTs is crucial to decrease the risk of complications and to improve the outcomes. Despite a limited sample size, this project reports positive preliminary results about the use of transcutaneous NIRS monitoring after paediatric KTs. The rat model should clarify the modifications of NIRS readings in case of vascular complications.File | Dimensione | Formato | |
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