2:10 - 2:30 pmSunday, September 18
LK 120
Live tissue staining as a new predicting clinical tool in organ transplantation
LK 120
Live tissue staining as a new predicting clinical tool in organ transplantation
Innsbruck Medical University
BackgroundMethods to assess the status of a graft prior to transplantation are the Holy Grail of transplantation as they could predict graft outcomes and enhance patient experience. They are highly desirable... Read more

Description

Background
Methods to assess the status of a graft prior to transplantation are the Holy Grail of transplantation as they could predict graft outcomes and enhance patient experience. They are highly desirable for selection of suitable organs, avoidance of unnecessary surgical interventions and optimisation of clinical outcomes, as delayed graft function (DGF) may lead to lengthy follow-up treatments or even organ loss.

The use of expanded-criteria donor kidneys demands careful pre-implantation assessment. However, histopathological analysis of the pre-transplant biopsy is time consuming and therefore makes extended criteria organs even riskier. Our aim is to establish a rapid assessment tool of donor kidney quality and investigate its predictive value for the clinical use.

Method
Based on the Biopsychronology study using rodent kidneys, done by Hermann/Ashraf et al., we started a prospective clinical trial at Innsbruck Medical University in October 2015 to implement live confocal real time analysis as a new predicting clinical tool in the clinical routine for deceased donor kidney transplantation. The stains used for confocal analysis are neither toxic, nor influencing the subsequent routine histological and immunohistological assessment. For this study, a semiquantitative score for quantification purposes of the imaging results has been created and is compared to/ correlated with the biopsy-histology result (using the Remuzzi score) and the clinical course of the recipients. The score displays the sum of viable cells divided by the number of dead cells per examined area (glomerulus, proximal and distal tubules; with an overall score of -3 (nonviable) up to +3 (100% viable). Statistical analyses are done with GraphPad Prism and SPSS.

Results
So far, 12 kidney transplant recipients (four female (30.77%); two retransplantations (16.7%)) have been included in the trial and successfully transplanted. The median recipient age was 59.03 years; the median donor age was 61.04 years. Mean ± SD cold ischemia time was 16.45 ± 3.7 hours. The median score for the real time imaging results was +1 (-1 to +3). Two patients developed DGF (16.7%) with a score of 1 in both; there was no primary non function. The mean ± SD serum creatinine and serum urea at discharge were 1.78 ± 0.74mg/dl and 73.33 ± 29.27mg/dl. No organ has been discarded so far on basis of the imaging result.

Conclusion
After including the first patients in our clinical trial, we could see that the approach is feasible and safe and the real time imaging provided us detailed information about the organ quality. In addition, it is possible to image exact the same biopsy area at the same time point. Furthermore, our method can be used straight away- less than half an hour- after taking the biopsy with the advantage of explaining our patients what is going on in their organ.

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