[Quantitative Intraoperative Measurement of Tissue Perfusion of Transplanted Kidneys by Indocyanine Green Angiography]. / Quantitative intraoperative Messung der Gewebeperfusion von Nierentransplantaten mittels Indocyaningrün-Angiografie.

Postoperative delayed graft function (DGF) after kidney transplantation is a risk factor for kidney failure and reduced kidney allograft survival after transplantation. The aim of this study was to measure the quantitative perfusion of kidney transplants during kidney transplantation and to investigate whether differences in perfusion predict the development of DGF. Over a period of one year, intraoperative quantitative ICG perfusion measurements were performed with the IC-View camera (Pulsion®) in 36 patients for whom informed consent for ICG perfusion measurement had been obtained. The groups were divided into donation after brain death and living donors and into the occurrence or absence of a DGF. An area with sufficient and low ICG perfusion was determined intraoperatively. The maximum perfusion was significantly decreased in the DGF group compared to living donors in areas with sufficient ICG perfusion and the slope of perfusion in these areas was documented. In addition, the maximum perfusion ratio was investigated. Evaluation was carried out by IC-Calc software (Pulsion). A total of 36 patients were included in this study. DGF occurred in 10 of the patients. No DGF was found in the group of living donors. The maximum perfusion and the slope of perfusion in the defined areas were fewer, but not significant in the group with BDB donor. The less perfused areas showed significant differences between DGF and living donors in maximum perfusion, absolute slope of perfusion and ratio to the standard area. A difference between BDB donor without DGF and the DGF group could not be predicted. This study shows that quantitative perfusion of kidney transplants can be evaluated safely during kidney transplantation. DGF being defined as one or more dialyses after kidney transplantation can only be detected postoperatively, however, it may be predicted intraoperatively.

CUP Syndrome in Neuroendocrine Neoplasia: Analysis of Risk Factors and Impact of Surgical Intervention.

BACKGROUND: Neuroendocrine neoplasia (NEN) with unknown primary site (NEN-CUP tumors) may have a poor prognosis. We evaluated the clinical presentation, therapy, outcome, and risk factors for adverse outcomes in patients who had these tumors. METHODS: In 243 patients who had NEN, a retrospective review was performed in 38 patients who had NEN-CUP tumors. The 38 patients who had NEN-CUP tumors were evaluated in three groups: group 1 (surgery; primary tumor detected; ten patients); group 2 (surgery; no primary tumor detected; ten patients); and group 3 (no surgery; 18 patients). Risk factors were evaluated with univariate and multivariate analyses. RESULTS: Most patients who had NEN-CUP tumors [32 patients (84%)] had World Health Organization (WHO) performance score of 0 or 1, and most tumors [24 patients (63%)] were well differentiated (WHO grade, G1 or G2; Ki-67 index, ≤20%). Univariate analysis showed that greater survival was significantly associated with lower patient age, lower WHO performance score, lower WHO grade, lower number of metastatic sites, treatment with surgery, and no treatment with chemotherapy. Multivariate analysis showed that low WHO performance score (hazard ratio 7.63, 95% confidence interval (CI) 2.63-22.19) and treatment with surgery (hazard ratio 0.10, CI 0.028-0.381) were significant independent predictors of improved survival. CONCLUSIONS: In patients with NEN-CUP tumors, surgical treatment is an independent predictor of better survival. Therefore, surgical treatment may be indicated in patients with good general health status and well-differentiated NEN-CUP tumors.