Impact of intraoperative assessment of renal allograft arterial blood flow on vascular complications and their prevention strategies

Objective: to use intraoperative fluorometry to assess the impact of renal allograft arterial blood flow on vascular complications.

Materials and methods. The study included 285 patients who underwent kidney transplantation (KT) at Shumakov National Medical Research Center of Transplantology and Artificial Organs (from May 2022 to July 2023). Patients were distributed into 2 comparison groups. Group 1 (49 patients, 17.2%) underwent intraoperative flowmetry, while group 2 (236 patients, 82.8%) did not. Following graft reperfusion, renal transplant arterial blood flow was measured in real time. Next, ureteroneocystostomy was performed, and then the graft was placed in the iliac fossa in its optimal position and the measurement was repeated.

Results. Intraoperative vascular complications occurred in 6 patients (12.2%) in the intraoperative flowmetry group. Those with vascular complications exhibited statistically significantly lower renal arterial volumetric blood flow (VBF) rate immediately after reperfusion (94 ± 93 vs. 291 ± 147; p = 0.002) and after reassessment at the end of ureteroneocystostomy (160 ± 88 vs. 349 ± 157; p = 0.006). A VBF of less than 120 mL/min contributed to the intraoperative decision to immediately revise the anastomosis. Following revision and reanastomosis of the arterial channel, there was no significant difference in VBF rate and PI values between recipients with the complications and the group without.

Conclusion. Prophylactic application of intraoperative fluorometry in KT allows to obtain objective data about the quality of vascular anastomosis and timely prevent irreversible vascular complications, thus preserving the renal graft in the postoperative period.

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