Ureterovesical Anastomosis Complications in Kidney Transplantation: Definition, Risk Factor Analysis, and Prediction by Quantitative Fluorescence Angiography with Indocyanine Green
Ureteral stenosis and urinary leakage are relevant problems after kidney transplantation. A standardized definition of ureterovesical anastomosis complications after kidney transplantation has not yet been established. This study was designed to demonstrate the predictive power of quantitative indoc...
| Main Authors: | , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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MDPI AG
2022-11-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/11/21/6585 |
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| author | Andreas L. H. Gerken Kai Nowak Alexander Meyer Maximilian C. Kriegmair Christel Weiss Bernhard K. Krämer Pauline Glossner Katharina Heller Ioannis Karampinis Frank Kunath Nuh N. Rahbari Kay Schwenke Christoph Reissfelder Werner Lang Ulrich Rother |
| author_facet | Andreas L. H. Gerken Kai Nowak Alexander Meyer Maximilian C. Kriegmair Christel Weiss Bernhard K. Krämer Pauline Glossner Katharina Heller Ioannis Karampinis Frank Kunath Nuh N. Rahbari Kay Schwenke Christoph Reissfelder Werner Lang Ulrich Rother |
| author_sort | Andreas L. H. Gerken |
| collection | DOAJ |
| description | Ureteral stenosis and urinary leakage are relevant problems after kidney transplantation. A standardized definition of ureterovesical anastomosis complications after kidney transplantation has not yet been established. This study was designed to demonstrate the predictive power of quantitative indocyanine green (ICG) fluorescence angiography. This bicentric historic cohort study, conducted between November 2015 and December 2019, included 196 kidney transplantations. The associations between quantitative perfusion parameters of near-infrared fluorescence angiography with ICG and the occurrence of different grades of ureterovesical anastomosis complications in the context of donor, recipient, periprocedural, and postoperative characteristics were evaluated. Post-transplant ureterovesical anastomosis complications occurred in 18%. Complications were defined and graded into three categories. They were associated with the time on dialysis (<i>p</i> = 0.0025), the type of donation (<i>p</i> = 0.0404), and the number of postoperative dialysis sessions (<i>p</i> = 0.0173). Median ICG ingress at the proximal ureteral third was 14.00 (5.00–33.00) AU in patients with and 23.50 (4.00–117.00) AU in patients without complications (<i>p</i> = 0.0001, cutoff: 16 AU, sensitivity 70%, specificity 70%, AUC = 0.725, <i>p</i> = 0.0011). The proposed definition and grading of post-transplant ureterovesical anastomosis complications is intended to enable valid comparisons between studies. ICG Fluorescence angiography allows intraoperative quantitative assessment of ureteral microperfusion during kidney transplantation and is able to predict the incidence of ureterovesical anastomosis complications. Registration number: NCT-02775838. |
| first_indexed | 2024-03-09T18:57:45Z |
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| id | doaj.art-84a683d6c0dc42d38bac96f311d9c896 |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-09T18:57:45Z |
| publishDate | 2022-11-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-84a683d6c0dc42d38bac96f311d9c8962023-11-24T05:20:05ZengMDPI AGJournal of Clinical Medicine2077-03832022-11-011121658510.3390/jcm11216585Ureterovesical Anastomosis Complications in Kidney Transplantation: Definition, Risk Factor Analysis, and Prediction by Quantitative Fluorescence Angiography with Indocyanine GreenAndreas L. H. Gerken0Kai Nowak1Alexander Meyer2Maximilian C. Kriegmair3Christel Weiss4Bernhard K. Krämer5Pauline Glossner6Katharina Heller7Ioannis Karampinis8Frank Kunath9Nuh N. Rahbari10Kay Schwenke11Christoph Reissfelder12Werner Lang13Ulrich Rother14Department of Surgery, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, D-68167 Mannheim, GermanyDepartment of Surgery, RoMed Hospital Rosenheim, Pettenkoferstraße 10, D-83022 Rosenheim, GermanyDepartment of Vascular Surgery, Friedrich Alexander University Erlangen-Nuremberg, Krankenhausstraße 12, D-91054 Erlangen, GermanyDepartment of Urology, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, D-68167 Mannheim, GermanyDepartment of Biometry and Statistics, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, D-68167 Mannheim, GermanyDepartment of Medicine V, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, D-68167 Mannheim, GermanyDepartment of Vascular Surgery, Friedrich Alexander University Erlangen-Nuremberg, Krankenhausstraße 12, D-91054 Erlangen, GermanyDepartment of Nephrology, Friedrich Alexander University Erlangen-Nuremberg, Krankenhausstraße 12, D-91054 Erlangen, GermanyDivision of Thoracic Surgery, Academic Thoracic Center Mainz, University Medical Center Mainz, Johannes Gutenberg University Mainz, Langenbeckstr. 1, D-55131 Mainz, GermanyDepartment of Urology and Pediatric Urology, Friedrich Alexander University Erlangen-Nuremberg, Krankenhausstraße 12, D-91054 Erlangen, GermanyDepartment of Surgery, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, D-68167 Mannheim, GermanyDepartment of Surgery, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, D-68167 Mannheim, GermanyDepartment of Surgery, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, D-68167 Mannheim, GermanyDepartment of Vascular Surgery, Friedrich Alexander University Erlangen-Nuremberg, Krankenhausstraße 12, D-91054 Erlangen, GermanyDepartment of Vascular Surgery, Friedrich Alexander University Erlangen-Nuremberg, Krankenhausstraße 12, D-91054 Erlangen, GermanyUreteral stenosis and urinary leakage are relevant problems after kidney transplantation. A standardized definition of ureterovesical anastomosis complications after kidney transplantation has not yet been established. This study was designed to demonstrate the predictive power of quantitative indocyanine green (ICG) fluorescence angiography. This bicentric historic cohort study, conducted between November 2015 and December 2019, included 196 kidney transplantations. The associations between quantitative perfusion parameters of near-infrared fluorescence angiography with ICG and the occurrence of different grades of ureterovesical anastomosis complications in the context of donor, recipient, periprocedural, and postoperative characteristics were evaluated. Post-transplant ureterovesical anastomosis complications occurred in 18%. Complications were defined and graded into three categories. They were associated with the time on dialysis (<i>p</i> = 0.0025), the type of donation (<i>p</i> = 0.0404), and the number of postoperative dialysis sessions (<i>p</i> = 0.0173). Median ICG ingress at the proximal ureteral third was 14.00 (5.00–33.00) AU in patients with and 23.50 (4.00–117.00) AU in patients without complications (<i>p</i> = 0.0001, cutoff: 16 AU, sensitivity 70%, specificity 70%, AUC = 0.725, <i>p</i> = 0.0011). The proposed definition and grading of post-transplant ureterovesical anastomosis complications is intended to enable valid comparisons between studies. ICG Fluorescence angiography allows intraoperative quantitative assessment of ureteral microperfusion during kidney transplantation and is able to predict the incidence of ureterovesical anastomosis complications. Registration number: NCT-02775838.https://www.mdpi.com/2077-0383/11/21/6585near-infraredNIRrenal transplantationperfusion assessment |
| spellingShingle | Andreas L. H. Gerken Kai Nowak Alexander Meyer Maximilian C. Kriegmair Christel Weiss Bernhard K. Krämer Pauline Glossner Katharina Heller Ioannis Karampinis Frank Kunath Nuh N. Rahbari Kay Schwenke Christoph Reissfelder Werner Lang Ulrich Rother Ureterovesical Anastomosis Complications in Kidney Transplantation: Definition, Risk Factor Analysis, and Prediction by Quantitative Fluorescence Angiography with Indocyanine Green Journal of Clinical Medicine near-infrared NIR renal transplantation perfusion assessment |
| title | Ureterovesical Anastomosis Complications in Kidney Transplantation: Definition, Risk Factor Analysis, and Prediction by Quantitative Fluorescence Angiography with Indocyanine Green |
| title_full | Ureterovesical Anastomosis Complications in Kidney Transplantation: Definition, Risk Factor Analysis, and Prediction by Quantitative Fluorescence Angiography with Indocyanine Green |
| title_fullStr | Ureterovesical Anastomosis Complications in Kidney Transplantation: Definition, Risk Factor Analysis, and Prediction by Quantitative Fluorescence Angiography with Indocyanine Green |
| title_full_unstemmed | Ureterovesical Anastomosis Complications in Kidney Transplantation: Definition, Risk Factor Analysis, and Prediction by Quantitative Fluorescence Angiography with Indocyanine Green |
| title_short | Ureterovesical Anastomosis Complications in Kidney Transplantation: Definition, Risk Factor Analysis, and Prediction by Quantitative Fluorescence Angiography with Indocyanine Green |
| title_sort | ureterovesical anastomosis complications in kidney transplantation definition risk factor analysis and prediction by quantitative fluorescence angiography with indocyanine green |
| topic | near-infrared NIR renal transplantation perfusion assessment |
| url | https://www.mdpi.com/2077-0383/11/21/6585 |
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