UBC Theses and Dissertations
Optical monitoring in kidney transplant Tolouei, Baharak
Background: Currently kidney transplant monitoring relies on clinical and laboratory parameters that may be associated with delayed diagnosis of graft dysfunction. The early detection of allograft abnormal function and institution of the appropriate medical or surgical interventions play a crucial role in allograft survival. Near Infra-Red Spectroscopy (NIRS) has well-known efficacy in non-invasive, continuous and real time monitoring of tissue oxygenation. This novel pilot study intends to assess the feasibility of using NIRS in monitoring transplanted kidney in pediatric recipients. Methods: The primary outcome was to assess the feasibility of NIRS monitoring in evaluating the allograft function, oxygenation, blood circulation and its association with graft function. Twenty patients in two groups (group one and two), participated in this project. NIRS sensor was placed once on the surgical site (upper pole of the allograft) and once at control site for all patients and the data was recorded to measure TOI % (Total Oxygen saturation Index), THI% (Tissue Hemoglobin concentration Index), HHb% (Deoxygenated Hemoglobin) in both surgical and opposite sites. Then we assessed the correlation between Total Oxygen Saturation Index in Surgical Site and Opposite Site with e-GFR, systolic blood pressure, Resistive Index and Hemoglobin. Result: Twenty participants range from 5 to 20 years old with a median age of 12.5 years old completed the study. 20 % of the participants were female, 35 % of the participants were living donor kidney recipients. All the participants tolerated the NIRS sensor and monitoring well, with a valid measurement on surgical and control sites. The study showed that TOI% on surgical site is correlated significantly with e-GFR adjusted for BMI using a linear regression model (P-value = 0.032). Conclusions: NIRS monitoring of transplanted kidney is a feasible and well tolerated method. Our study showed a significant positive correlation between TOISS% and e-GFR. However, the specification restrictions of the available NIRS sensors may limit our ability to get an accurate signal from the target organs in larger patients. Our findings serve as a preliminary benchmark for quality improvement in this field. The process and outcome of this project has identified areas of opportunities to improve this novel approach.
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