Non-Invasive Evaluation of Transplant Kidney using OCT

描述（由申请人提供）：目前全球范围内缺乏用于移植的肾脏，主要原因是没有可靠的方法来确定其活力 (i.e.,长期储存的肾脏等）。此外，移植后，肾脏通常不能立即发挥功能，其状态也不清楚。以前，我们已经表明，活的，浅表的，肾近曲小管的组织病理学是一个很好的指标，肾的活力和移植后肾功能。事实上，浅表近端小管的组织病理学反映了整个肾皮质中近曲肾的状态。然而，重要的是，近曲小管在非侵入性和存活状态下成像，因为它们对缺血的显著敏感性已得到证实（即，例如与切除活检相关）。光学相干断层扫描（OCT）是一种新兴的成像技术，它可以原位和真实的实时获得生物组织的高分辨率、非侵入性的横截面图像。在我们最近发表的论文中，我们已经证明，OCT将提供新的非侵入性，实时的肾脏组织病理学信息，这是不可能获得使用任何其他已知的程序。在活体供肾的初步临床试验（27例患者）中，我们已经证明，在移植前和移植后的人肾组织病理学OCT成像可用于预测移植后肾功能。此外，这些初步试验已经证明，在手术室中使用手持设备对人类供体肾脏进行OCT成像是安全的，并且可以在短时间内对整个肾脏进行评估。最后，我们最近已经证明，OCT可以在多普勒模式（DOCT）中用于成像肾血流，甚至在个体肾小球中（即，肾小球血流）。这些DOCT图像提供了肾/肾小球功能和病理学的额外测量。在本研究中，我们将开发一种先进的超高速扫频OCT/DOCT成像系统，以评估肾移植前后人类供体肾的组织病理学。这些OCT/DOCT成像研究将与移植后肾功能相关，以制定OCT评价移植肾活力的成像指南和相关算法。拟议的研究将通过最有效地利用可用的供体肾脏来增加可用于移植的健康肾脏的数量，消除可能使用坏的供体肾脏（即，过度损伤的缺血性或患病的肾），提供预期的移植后肾功能的测量，并允许更好地区分移植后免疫排斥和缺血性诱导的急性肾衰竭。

DESCRIPTION (provided by applicant): There is currently a worldwide shortage of kidneys for transplantation due mainly to the fact that there is no reliable means to determine their viability (i.e., kidneys stored for long periods of time, etc.). Also, following transplantation, kidneys oftn do not function immediately and their status is unclear. Previously, we have shown that the histopathology of living, superficial, kidney proximal convoluted tubules is a good indicator of kidney viability and post-transplant renal function. Indeed, the histopathology of superficial proximal tubules reflects the status of the proximal convoluted kidneys throughout the entire kidney cortex. It is important, however, that proximal convoluted tubules are imaged in a non-invasive and living state because of their well- established dramatic sensitivity to ischemia (i.e. such as associated with excision biopsies). Optical coherence tomography (OCT) is an emerging imaging technology that can obtain high resolution, non-invasive, cross- sectional images of biological tissues in situ and in real time. In our recently published papers, we have demonstrated that OCT will provide novel non-invasive, real-time histopathological information of the kidney that is impossible to obtain using any other known procedure. In a preliminary clinical trial (27 patients) of living human donor kidneys, we have demonstrated that OCT imaging of human kidney histopathology both prior to and following their transplant can be used to predict post-transplant renal function. Furthermore, these preliminary trials have demonstrated that OCT imaging of human donor kidneys with a hand-held unit in the operating room is safe and that the entire kidney can be evaluated within a short period of time. Finally, we have recently demonstrated that OCT can be used in a Doppler mode (DOCT) to image renal blood flow, even in individual glomeruli (i.e., glomerular blood flow). These DOCT images provide an additional measure of renal/glomerular function and pathology. In this proposal, we will develop an advanced ultrahigh-speed swept- source OCT/DOCT imaging system to evaluate the histopathology of human donor kidneys prior to and following renal transplant. These OCT/DOCT imaging studies will be correlated with post-transplant renal function in order to develop imaging guidelines and associated algorithms for OCT evaluation of kidney viability for transplant. The proposed studies will increase the number of healthy kidneys available for transplantation by making the most efficient use of available donor kidneys, eliminating the possible use of bad donor kidneys (i.e., excessively damaged ischemic or diseased kidneys), providing a measure of expected post-transplant renal function, and allowing better distinction between post-transplant immunological rejection and ischemic- induced acute renal failure.