Pd56-06 Indocyanine Green Fluorescence for Preventing Early Ureteral Complications in Kidney Transplantation: Procedural Flowchart and Clinical Outcomes

You have accessJournal of UrologyTransplantation & Vascular Surgery II (PD56)1 May 2024PD56-06 INDOCYANINE GREEN FLUORESCENCE FOR PREVENTING EARLY URETERAL COMPLICATIONS IN KIDNEY TRANSPLANTATION: PROCEDURAL FLOWCHART AND CLINICAL OUTCOMES Shang Yuan Hsu and Shen Shin Chang Shang Yuan HsuShang Yuan Hsu and Shen Shin ChangShen Shin Chang View All Author Informationhttps://doi.org/10.1097/01.JU.0001008928.01012.0d.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: This study aimed to evaluate the efficacy of utilizing Indocyanine green (ICG) to prevent early ureteral complications following kidney transplantation by assessing perfusion in the distal ureter. METHODS: Selected kidney transplant patients with inadequate peri-ureteral connective tissue preservation underwent this intraoperative procedure by using intravenous indocyanine green. A diluted solution of ICG was injected after vascular anastomosis completion. A fluorescence imaging system was utilized to detect reperfusion in the graft ureter. If the distal ureter did not exhibit fluorescent color under the illumination instrument, it was inferred that this segment might be hypoperfused and potentially predisposing it to postoperative urinary leak. Subsequently, based on the fluorescence level, the distal ureter was appropriately trimmed, determining the optimal site for ureteroneocystostomy to minimize tension and ensure adequate perfusion. RESULTS: The intraoperative application of ICG fluorescence provided real-time information on perfusion territories, allowing for immediate decisions during the surgical procedure. The technique facilitated modifications to the graft ureter's length and identification of suitable anastomosis locations. When the remaining graft ureter was insufficient in length for ureteroneocystostomy, alternative techniques were considered. Patients underwent this procedure, none experiencing postoperative urine leakage. Long-term follow- up showed no complications. A procedural flowchart was developed to address perfusion defects in the graft ureter affected by compromised peri-ureteral connective tissue. CONCLUSIONS: The application of ICG fluorescence in selected renal grafts during kidney transplantation surgery holds promise in potentially reducing the incidence of early ureteral necrosis due to ischemia. The experience gained from the successful application of this technique in the selected patients, without any postoperative urine leakage and no long-term complications. The developed procedural flowchart offering a new perspective in preventing early ureteral complications after kidney transplantation. Download PPT Source of Funding: Taiwan's National Health Insurance © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e1204 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Shang Yuan Hsu More articles by this author Shen Shin Chang More articles by this author Expand All Advertisement PDF downloadLoading ...