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Hyperspectral Imaging (HSI) of Human Kidney Allografts. OBJECTIVE: Aim of our study was to test a non-invasive Hyperspectral Imaging (HSI) technique as an intraoperative real time assessment tool for deceased donor kidney quality and function in human kidney allotransplantation. SUMMARY BACKGROUND DATA: HSI is capable to deliver quantitative diagnostic information about tissue pathology, morphology and composition, based on the spectral characteristics of the investigated tissue. Since tools for objective intraoperative graft viability and performance assessment are lacking, we applied this novel technique to human kidney transplantation. METHODS: Hyperspectral images of distinct components of kidney allografts (parenchyma, ureter) were acquired 15 and 45 minutes after reperfusion and subsequently analyzed using specialized HSI acquisition software capable to compute oxygen saturation levels (StO2), near infrared perfusion indices (NIR), organ hemoglobin indices (OHI) and tissue water indices (TWI) of explored tissues. RESULTS: Seventeen kidney transplants were analyzed. Median recipient and donor age were 55 years. Cold ischemia time (CIT) was 10.8 ± 4.1 hours and anastomosis time was 35 ± 7 minutes (mean ± SD). Two patients (11.8%) developed DGF. CIT was significantly longer (18.6 ± 1.6) in patients with DGF (p < 0.01). Kidneys with DGF furthermore displayed significant lower StO2 (p = 0.02) and NIR perfusion indices, 15 min after reperfusion (p < 0.01). Transplant ureters displayed a significant decrease of NIR perfusion with increased distance to the renal pelvis, identifying well and poor perfused segments. CONCLUSION: Intraoperative HSI is feasible and meaningful to predict DGF in renal allografts. Furthermore, it can be utilized for image guided surgery, providing information about tissue oxygenation, perfusion, hemoglobin concentration and water concentration, hence allowing intraoperative viability assessment of the kidney parenchyma and the ureter.