It has been shown in various publications that delayed allograft function has a detrimental effect on long-term survival. As the waiting list for transplants grows exponentially, the utilization of expanded-criteria and non-heart-beating organs are being considered as alternative organs to expand the donor pool and reduce the number of people waiting for transplantation. These are organs that come from non-ideal donors that in the past were deemed unsuitable for transplantation. Although these organs have been shown to have worse survival rates compared to traditional brain dead organs, in selected trials they have been shown to provide reasonable graft function. In order to obtain acceptable results on a more regular basis, pulsatile preservation has been used to resuscitate expanded-criteria and non-heart-beating donor kidneys to avoid the detrimental effects of ischemia and donor injury on the kidneys prior to transplantation. An improved method is needed to facilitate targeted resuscitation with local perfusate delivery. Currently there is no objective measure of the local effects of ischemia in real-time, nor means to evaluate resuscitation attempts. An IR method utilizing a focal plane array IR detector camera was developed in 2003-2004 for real-time intraoperative imaging of renal allografts and demonstrated the ability of IR imaging to evaluate renal perfusion in real time and predict subsequent outcome after reperfusion. We propose to use infrared (IR) imaging to guide renal transplant resuscitation and over the last year have developed the method and obtained pilot data to demonstrate the potential utility of this approach. Intraoperative IR imaging was modified to monitor cadaveric perfused organs non-invasively, in real-time and without disrupting cold perfusion. As the organ's temperature is directly related to perfusate temperature, and IR imaging is exquisitely sensitive, this method could provide a means to objectively assess cortical perfusion by measuring physiologically significant changes) in temperature (e.g. 3 - 5 degrees C after an injection of 5 degree C preservation fluid) and relating them to ischemia induced vasospasm. This method has the advantage of imaging entire fields and allowing for assessment of specific areas and/or aggregate assessment of large areas. This technology may aide in the objective assessment of resuscitation designed to enhance perfusion, and allow for quantitative assessment of resuscitation related damage. It may also allow for an objective measure of viability, as response to resuscitation should predict subsequent behavior post transplantation. A study is underway evaluating resuscitation interventions (e.g. infusion of calcium channel blockers or other vasodilating agents). In summary, the use of IR imaging while the organs are on the perfusion circuit may be a valuable prognostic indicator. It usually takes between four to six hours to evaluate the viability of the organ on the perfusion circuit, during which time IR assessments may allow for determination of organ viability.
