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End-stage renal disease (ESRD) is a serious medical condition characterized by an irreversible decline in kidney function. The optimal treatment for ESRD is kidney transplantation, providing improved quality and quantity of life and lower mortality rates compared to other treatments. While there exists a vast constellation of variables that contribute to the ultimate success of a kidney transplant, timely diagnosis of allograft dysfunction and its underlying etiology is crucial in informing appropriate treatment plans and improving graft survival rates. The monitoring and diagnosis of early postoperative allograft function may involve regular bloodwork for renal function testing, percutaneous kidney biopsy, and intermittent transabdominal ultrasonography, all of which have inherent limitations and risks. Objective intraoperative assessment of graft quality and perfusion characteristics lacks reliable and safe techniques in kidney transplantation. We propose applying a novel optical technique based on near-infrared imaging (NIRI) for intraoperative interrogation of allograft metabolic function. The objectives of this study were to examine the feasibility and functionality of a non-contact, non-invasive, handheld NIRI device for intraoperative monitoring of graft hemodynamics and oxygenation during transplantation. Intraoperative NIRI assessment of the kidney parenchyma tissue oxygen saturation (StO2) was performed for 25 transplants. Images of the allograft were taken at the back table after preparation, in-situ before perfusion, at the earliest convenience after reperfusion, and then at 1, 2, 3, 4, 5, 10, 15, 20, and 25 minutes following reperfusion. A final image was taken before closure. The kidney parenchyma tissue was digitally segmented and the average parenchymal StO2 was calculated at each time point. All patients showed low StO2 in the images taken before reperfusion, with an increase in StO2 seen after clamp removal. Our study demonstrated the feasibility and functionality of a handheld NIRI device for intraoperative monitoring of kidney graft hemodynamics and oxygenation during transplantation. For future studies, clinical measures, and additional hemodynamic parameters, such as the velocity in reaching max StO2, will be compared for donor kidneys of varying quality.
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