Original Paper

In vivo Visualization of Early Microcirculatory Changes following Ischemia/Reperfusion Injury in Human Kidney Transplantation
V. Schmitz^a, K.-D. Schaser^b, P. Olschewski^a, P. Neuhaus^a, G. Puhl<sup>a

a</sup>Department of General, Visceral and Transplantation Surgery, and
^bCenter for Musculoskeletal Surgery, University Medicine Berlin, Charité, Campus Virchow, Berlin, Germany

Address of Corresponding Author

Eur Surg Res 2008;40:19-25 (DOI: 10.1159/000107683)

  Key Words

• Ischemia reperfusion injury
• Renal transplantation
• Microcirculation
• Orthogonal polarization spectral imaging

  Abstract

To determine whether microcirculatory changes following ischemia/reperfusion (I/R) may serve as predictors for subsequent graft dysfunction, we used noninvasive orthogonal polarization spectral (OPS) imaging to directly visualize and quantify cortical kidney microcirculation. In a total of 13 combined kidney/pancreas recipients, following reperfusion (5/30 min) microcirculatory parameters such as capillary diameter, functional capillary density (FCD) and red-blood-cell velocity (V_RBC) of the renal graft were analyzed. From these parameters, a heterogeneity index (HI) and volumetric capillary blood flow (vCBF) were calculated. In addition, the extent of graft injury was determined by daily analysis of serum creatinine, blood urea nitrogen, C-reactive protein and systemic leukocyte count for 7 days post-transplant. At early reperfusion, a heterogeneous perfusion pattern with oscillating flow and scattered microvascular thrombosis of peritubular capillaries, resembling a 'no reflow', was observed. FCD was constant throughout the entire reperfusion period, whereas HI, capillary diameters, V_RBC and vCBF increased. The latter showed a significant positive correlation with creatinine changes between days 1 and 3. So far our finding of a positive correlation of early microvascular changes (vCBF) and clinical parameters (creatinine) indicate a possible therapeutic implication of OPS imaging to predict early I/R-induced renal graft dysfunction.

Copyright © 2008 S. Karger AG, Basel

  Author Contacts

Volker Schmitz
Charité, Campus Virchow
Department of General, Visceral and Transplantation Surgery
Augustenburger Platz 1, DE-13353 Berlin (Germany)
Tel. +49 30 450 552 002, Fax +49 30 450 552 900, E-Mail volker.schmitz@charite.de

  Article Information

V. Schmitz and K.-D. Schaser contributed equally to the manuscript.

Received: April 2, 2007
Accepted after revision: June 17, 2007
Published online: August 29, 2007
Number of Print Pages : 7
Number of Figures : 2, Number of Tables : 2, Number of References : 32