Safety and Feasibility of Renal Blood Flow Determination During Kidney Transplant Surgery with Perfusion Ultrasonography

Abstract

In the United States over 30,000 patients with end-stage renal disease await donor kidneys for transplantation. The strategies for anesthetic management of patients donating or receiving transplanted kidneys include manipulations aimed at maximizing graft viability and immediate function while minimizing rejection. These strategies are important because the loss of a transplant kidney, especially from a living donor, is a catastrophe, given the limited supply and large demand.

Even distribution of adequate renal blood flow is a major determinant of postreperfusion transplant kidney function. Clinically, this is assessed by color of die kidney, palpation of the “fullness” of the kidney, and by Doppler signal of pulsatile blood flow. Urine production is reassuring, but the lack of urine flow is not a reliable indicator of adequate arterial perfusion.

This preliminary study shows that an albumin-stabilized solution of microspheres (Albunex®) is nontoxic, hemodynamically inert, and provides good image-enhancement for ultrasonographic evaluation of cortical and medullary renal blood flow. Enhanced ultrasonography is likely to provide a sensitive means of assessment of renal blood flow in a transplanted kidney immediately after reperfusion. The only disadvantage to the technique is that it requires cannulation of die external iliac artery for injection proximal to die transplanted renal artery.