Pre-transplant kidney quality evaluation using photoacoustic imaging during normothermic machine perfusion

IF 7.1 1区医学 Q1 ENGINEERING, BIOMEDICAL

Photoacoustics Pub Date : 2024-02-09 DOI:10.1016/j.pacs.2024.100596

Anton V. Nikolaev , Yitian Fang , Jeroen Essers , Kranthi M. Panth , Gisela Ambagtsheer , Marian C. Clahsen-van Groningen , Robert C. Minnee , Gijs van Soest , Ron W.F. de Bruin

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引用次数: 0

Abstract

Due to the shortage of kidneys donated for transplantation, surgeons are forced to use the organs with an elevated risk of poor function or even failure. Although the existing methods for pre-transplant quality evaluation have been validated over decades in population cohort studies across the world, new methods are needed as long as delayed graft function or failure in a kidney transplant occurs. In this study, we explored the potential of utilizing photoacoustic (PA) imaging during normothermic machine perfusion (NMP) as a means of evaluating kidney quality. We closely monitored twenty-two porcine kidneys using 3D PA imaging during a two-hour NMP session. Based on biochemical analyses of perfusate and produced urine, the kidneys were categorized into ‘non-functional’ and ‘functional’ groups. Our primary focus was to quantify oxygenation (sO₂) within the kidney cortical layer of depths 2 mm, 4 mm, and 6 mm using two-wavelength PA imaging. Next, receiver operating characteristic (ROC) analysis was performed to determine an optimal cortical layer depth and time point for the quantification of sO₂ to discriminate between functional and non-functional organs. Finally, for each depth, we assessed the correlation between sO₂ and creatinine clearance (CrCl), oxygen consumption (VO₂), and renal blood flow (RBF).

We found that hypoxia of the renal cortex is associated with poor renal function. In addition, the determination of sO₂ within the 2 mm depth of the renal cortex after 30 min of NMP effectively distinguishes between functional and non-functional kidneys. The non-functional kidneys can be detected with the sensitivity and specificity of 80% and 85% respectively, using the cut-off point of sO₂ < 39%. Oxygenation significantly correlates with RBF and VO₂ in all kidneys. In functional kidneys, sO₂ correlated with CrCl, which is not the case for non-functional kidneys.

We conclude that the presented technique has a high potential for supporting organ selection for kidney transplantation.

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在常温机器灌注过程中使用光声成像进行移植前肾脏质量评估

由于捐献用于移植的肾脏短缺，外科医生不得不使用功能低下甚至衰竭风险较高的器官。尽管现有的移植前质量评估方法已在几十年的全球人群队列研究中得到验证，但只要肾移植中出现移植功能延迟或失败，就需要新的方法。在这项研究中，我们探索了在常温机器灌注（NMP）过程中利用光声学（PA）成像评估肾脏质量的可能性。在两小时的 NMP 过程中，我们使用三维 PA 成像密切监测了 22 个猪肾。根据灌注液和产生的尿液的生化分析，我们将这些肾脏分为 "无功能 "组和 "有功能 "组。我们的主要重点是使用双波长 PA 成像技术量化深度分别为 2 毫米、4 毫米和 6 毫米的肾脏皮质层内的氧饱和度（sO2）。接着，我们进行了接收器操作特征（ROC）分析，以确定量化 sO2 的最佳皮质层深度和时间点，从而区分功能性和非功能性器官。最后，针对每个深度，我们评估了 sO2 与肌酐清除率（CrCl）、耗氧量（VO2）和肾血流量（RBF）之间的相关性。此外，通过测定 NMP 30 分钟后肾皮质 2 毫米深度内的 sO2，可以有效区分功能性肾脏和非功能性肾脏。以 sO2 < 39% 为临界点，非功能性肾脏的检测灵敏度和特异度分别为 80% 和 85%。在所有肾脏中，氧饱和度与 RBF 和 VO2 都有明显的相关性。在功能性肾脏中，sO2 与 CrCl 相关，而在非功能性肾脏中则不然。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Photoacoustics Physics and Astronomy-Atomic and Molecular Physics, and Optics

CiteScore

11.40

自引率

16.50%

发文量

审稿时长

53 days

期刊介绍： The open access Photoacoustics journal (PACS) aims to publish original research and review contributions in the field of photoacoustics-optoacoustics-thermoacoustics. This field utilizes acoustical and ultrasonic phenomena excited by electromagnetic radiation for the detection, visualization, and characterization of various materials and biological tissues, including living organisms. Recent advancements in laser technologies, ultrasound detection approaches, inverse theory, and fast reconstruction algorithms have greatly supported the rapid progress in this field. The unique contrast provided by molecular absorption in photoacoustic-optoacoustic-thermoacoustic methods has allowed for addressing unmet biological and medical needs such as pre-clinical research, clinical imaging of vasculature, tissue and disease physiology, drug efficacy, surgery guidance, and therapy monitoring. Applications of this field encompass a wide range of medical imaging and sensing applications, including cancer, vascular diseases, brain neurophysiology, ophthalmology, and diabetes. Moreover, photoacoustics-optoacoustics-thermoacoustics is a multidisciplinary field, with contributions from chemistry and nanotechnology, where novel materials such as biodegradable nanoparticles, organic dyes, targeted agents, theranostic probes, and genetically expressed markers are being actively developed. These advanced materials have significantly improved the signal-to-noise ratio and tissue contrast in photoacoustic methods.