Title
Real-time laser speckle contrast imaging measurement during normothermic machine perfusion in pretransplant kidney assessment
Author
Fang, Yitian (Erasmus MC)
van Ooijen, Lisanne (Student TU Delft)
Ambagtsheer, Gisela (Erasmus MC)
Nikolaev, Anton V. (Erasmus MC)
Clahsen-van Groningen, Marian C. (Erasmus MC; RWTH Aachen University)
Dankelman, J. (TU Delft Medical Instruments & Bio-Inspired Technology) 
de Bruin, Ron W.F. (Erasmus MC)
Minnee, Robert C. (Erasmus MC)
Date
2023
Abstract
Objectives: Normothermic machine perfusion (NMP) provides a platform for pre-transplant kidney quality assessment that is essential for the use of marginal donor kidneys. Laser speckle contrast imaging (LSCI) presents distinct advantages as a real-time and noncontact imaging technique for measuring microcirculation. In this study, we aimed to assess the value of LSCI in visualizing renal cortical perfusion and investigate the additional value of dual-side LSCI measurements compared to single aspect measurement during NMP. Methods: Porcine kidneys were obtained from a slaughterhouse and then underwent NMP. LSCI was used to measure one-sided cortical perfusion in the first 100 min of NMP. Thereafter, the inferior renal artery branch was occluded to induce partial ischemia and LSCI measurements on both ventral and dorsal sides were performed. Results: LSCI fluxes correlated linearly with the renal blood flow (R2 = 0.90, p < 0.001). After renal artery branch occlusion, absence of renal cortical perfusion could be visualized and semiquantified by LSCI. The overall ischemic area percentage of the ventral and dorsal sides was comparable (median interquartile range [IQR], 38 [24−43]% vs. 29 [17−46]%, p = 0.43), but heterogenous patterns between the two aspects were observed. There was a significant difference in oxygen consumption (mean ± standard deviation [SD], 2.57 ± 0.63 vs. 1.83 ± 0.49 mLO2/min/100 g, p < 0.001), urine output (median [IQR], 1.3 [1.1−1.7] vs. 0.8 [0.6−1.3] mL/min, p < 0.05), lactate dehydrogenase (mean ± SD, 768 ± 370 vs. 905 ± 401 U/L, p < 0.05) and AST (mean ± SD, 352 ± 285 vs. 462 ± 383 U/L, p < 0.01) before and after renal artery occlusion, while no significant difference was found in creatinine clearance, fractional excretion of sodium, total sodium reabsorption and histological damage. Conclusions: LSCI fluxes correlated linearly with renal blood flow during NMP. Renal cortical microcirculation and absent perfusion can be visualized and semiquantified by LSCI. It provides a relative understanding of perfusion levels, allowing for a qualitative comparison between regions in the kidney. Dual-side LSCI measurements are of added value compared to single aspect measurement and renal function markers.
Subject
kidney quality assessment
laser speckle contrast imaging
normothermic machine perfusion
renal cortical microcirculation
To reference this document use:
http://resolver.tudelft.nl/uuid:65493e90-cc7e-4360-828e-64f9eb83320f
DOI
https://doi.org/10.1002/lsm.23715
ISSN
0196-8092
Source
Lasers in Surgery and Medicine, 55 (8), 784-793
Part of collection
Institutional Repository
Document type
journal article
Rights
© 2023 Yitian Fang, Lisanne van Ooijen, Gisela Ambagtsheer, Anton V. Nikolaev, Marian C. Clahsen-van Groningen, J. Dankelman, Ron W.F. de Bruin, Robert C. Minnee