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NEAR-INFRARED SPECTROSCOPY (NIRS) AS A CONTINUOUS REAL-TIME MONITORING FOR KIDNEY GRAFT PERFUSION

Questo Abstract è stato accettato come Comunicazione.

Abstract

INTRODUZIONE. Near-infrared spectroscopy (NIRS) is a technique designed to study regional oxygenation (rSO2) by measuring absorption of tissue chromophores. It has been validated for measurement of cerebral tissue O2 saturation in neonates but few data exist on splanchnic perfusion evaluation.

The aim of our study was to investigate the role of NIRS in monitoring for kidney graft perfusion in the first 72 hrs post-transplantation.

MATERIALI e METODI. Consecutive children undergoing living related (LR) or deceased donor (DD) kidney transplantation (KTP) were prospectively enrolled between April 2010 and July 2011. NIRS probe was applied in operatory room upon surgical suture. The values of renal rSO2 have been continuously registered for 3 days and correlated with the following markers of renal perfusion:

- hourly urine output;

- serum creatinine (SCr) and urinary neutrophil gelatinase-associated lipocalin (U-NGAL) collected every 12 hrs;

- daily Power and Color Flow Doppler ultrasound (CDUS) to assess global renal perfusion and intra-renal resistive index (RI).

RISULTATI e CONCLUSIONI. Twenty-four children were included, 6 underwent LR-KTP and 17 DD-KTP. Median age at KTP was 12.5 yrs (range 1-17.8) and median weight was 37 kg (range 9.5-72). Immunosuppression (IS) was induced with steroids and basiliximab; thereafter, the IS regimen consisted of prednisone with Tac and MMF. Four patients experienced DGF. In all children Power and CDUS showed normal vascularisation patterns and RI (median value 0.63; 0.56-0.78). During the study period:

- mean graft rSO2 trend showed a progressive increase from baseline to 72 hrs post-KTP (p<0.001) (Figure);

- graft rSO2 values showed a significant correlation with both SCr (r=-0.58;p<0.05) and creatinine clearance (r=-0.54;p<0.05);

- graft rSO2 values showed a significant negative correlation with U-NGAL trend in both DD (r=-0.96;p<0.001) and LRD-KTP (r=-0.89;p<0.001).

Our results suggest that NIRS monitoring could became a useful non-invasive tool for a real-time evaluation of kidney graft perfusion during the first hours after transplantation, a tricky phase when an ischemic insult could benefit from prompt medical or surgical treatment.

E. Vidal(1), A. Amigoni(2), M.C. Varagnolo(3), E. Benetti(1), G. Ghirardo(1), V. Brugnolaro(2), L. Murer(1)
((1)UOS Nefrologia Pediatrica, Dialisi e Trapianto; Dipartimento di Pediatria; Azienda Ospedaliera-Università di Padova , (2)UOS Terapia Intensiva Pediatrica; Dipartimento di Pediatria; Azienda Ospedaliera-Università di Padova , (3)UOC Medicina di Laboratorio; Azienda Ospedaliera di Padova )
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Realizzazione: Tesi S.p.A.

Per assistenza contattare: Claudia Ingrassia, Tesi S.p.A.
0172 476301 — claudia.ingrassia@gruppotesi.com