Fluorescence ureteral angiography with indocyanine green for the prevention of urological complications in kidney transplantation

Background. Some of the most common complications following kidney transplantation are urological complications. According to the literature, local tissue ischemia plays a crucial role in their development. Numerous studies have confirmed the effectiveness and safety of fluorescence imaging with indocyanine green (ICG) for assessing organ perfusion. However, this technique has not yet been widely integrated into kidney transplantation practice.

Objective. Improving kidney transplantation outcomes through the implementation of a fluorescent ureteral angiography protocol with ICG for the prevention of urological complications.

Material and method. This retrospective study analyzed the treatment outcomes in 294 kidney transplant recipients. Group I included 233 patients who underwent transplantation between 2018 and 2021. Neoureterocystoanastomosis was performed in all cases using Barry’s extravesical anti-reflux technique. The incidence and risk factors for urological complications were assessed. Based on these findings, a fluorescence-guided approach to forming the Neoureterocystoanastomosis was developed and implemented into clinical practice. If fluorescence imaging confirmed satisfactory ureteral perfusion, the anastomosis was performed using the standard method. If fluorescence findings were unfavourable, an excessive ureteral length was resected within the well-perfused zone, and a non-tunneled anastomosis was performed. Group II included 61 kidney transplant recipients operated on between 2022 and 2023, who underwent transplantation using this fluorescence-guided method.

Results. The incidence of urological complications in Group I was 12.0% (28/233). No significant correlation was identified between complications and potential risk factors. In seven cases in Group II, unfavourable fluorescence findings required extended ureteral resection and non-tunneled anastomosis. A comparative analysis demonstrated that the use of fluorescence angiography reduced the risk of urological complications three-fold (12% vs. 3.3%, p=0.045).

Conclusions. Fluorescence angiography of the transplanted kidneу ureter is a safe and effective imaging technique that contributes to preventing urological complications. This approach ensures anastomosis formation within well-perfused tissues, reducing postoperative risks and improving transplant outcomes.

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