Abstract
Current measures for assessing the viability of donor kidneys are lacking. Optical coherence tomography (OCT) can image subsurface tissue morphology to supplement current measures and potentially improve prediction of post-transplant function. OCT imaging was performed on donor kidneys before and immediately after implantation during 169 human kidney transplant surgeries. A system for automated image analysis was developed to measure structural parameters of the kidney's proximal convoluted tubules (PCTs) visualized in the OCT images. The association of these structural parameters with post-transplant function was investigated. This study included kidneys from live and deceased donors. 88 deceased donor kidneys in this study were stored by static cold storage (SCS) and an additional 15 were preserved by hypothermic machine perfusion (HMP). A subset of both SCS and HMP deceased donor kidneys were classified as expanded criteria donor (ECD) kidneys, with elevated risk of poor post-transplant function. Post-transplant function was characterized as either immediate graft function (IGF) or delayed graft function (DGF). In ECD kidneys stored by SCS, increased PCT lumen diameter was found to predict DGF both prior to implantation and following reperfusion. In SCD kidneys preserved by HMP, reduced distance between adjacent lumen following reperfusion was found to predict DGF. Results suggest that OCT measurements may be useful for predicting post-transplant function in ECD kidneys and kidneys stored by HMP. OCT analysis of donor kidneys may aid in allocation of kidneys to expand the donor pool as well as help predict post-transplant function in transplanted kidneys to inform post-operative care.
Highlights
The number of people on the waiting list for a kidney transplant grows each year and efforts to expand the donor pool to meet this demand have fallen short [1]
3.1 Comparison of automatic and manual segmentation Automatic segmentation performed on images which were manually segmented (~1,500 images) had a capsule-cortex interface with a mean absolute error (MAE) of 15.0 ± 10.7 μm (5.2 ± 3.7 pixels) as compared to the manual segmentations (top yellow, blue and red lines in Fig. 15(b) for automatic and the 2 manual raters respectively)
Automatic segmentation performed on images which were manually segmented produced a quantifiable cortex boundary (line across x-axis highlighting the point at which signal transitions into noise, represented by the bottom yellow, blue and red lines in Fig. 15(b) for automatic and the 2 manual raters respectively) with a MAE of 45.0 ± 11.23 μm (4.0 ± 2.0 pixels) as compared with manual segmentations
Summary
The number of people on the waiting list for a kidney transplant grows each year and efforts to expand the donor pool to meet this demand have fallen short [1]. Kidney offers have expanded to include higher risk donors with various comorbidities, suboptimal procurement, and longer cold ischemia times. The inclusion of these higher risk, expanded criteria donors (ECD) in the donor pool has been successful in increasing the number of transplants performed annually but transplant centers still discard a large portion of ECD kidneys procured and offered for transplant [2,3,4]. The discard rate for ECD kidneys is nearly 45% compared to just over 10% for standard criteria donor (SCD) kidneys [5] These discards represent a largely untapped source of potentially viable kidneys which, if properly utilized, could further widen the donor pool and narrow the gap between kidney supply and kidney demand. It is estimated that this number could be as high as 38,000 if more marginally compromised kidneys were considered and the donor pool properly utilized [8]
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