Indocyanine green dye clearance test: early graft (dys)-function and long-term mortality after liver transplant. Should we continue to use it? An observational study

Cherchi, Vittorio; Vetrugno, Luigi; Zanini, Victor; Isler, Thomas; Pravisani, Riccardo; Borghi, Alice; Baccarani, Umberto; Terrosu, Giovanni; Risaliti, Andrea; Bove, Tiziana

doi:10.1007/s10877-020-00493-z

Cited by 9 publications

(21 citation statements)

References 31 publications

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“…Despite the evident effectiveness and reliability of bile output as a direct marker of liver graft function, in recent years, several non-invasive assessment methods have been developed, with comparable prognostic power [ 12 – 14 ]. The indocyanine green—plasma disappearance rate (ICG-PDR), either used as an intraoperative or early postoperative functional parameter, was demonstrated to be an effective predictor of early allograft dysfunction (EAD), primary non-function (PNF), and patient and graft survival [ 12 , 13 , 15 ]. Another functional test which has been developed and validated in liver resection surgery but recently applied also to LT, is the Liver Maximal Function Capacity (LiMax) which has been identified as an effective and early (within 24 h after LT) predictor of EAD/PNF [ 13 , 14 ].…”

Section: Discussionmentioning

confidence: 99%

An Italian survey on the use of T-tube in liver transplantation: old habits die hard!

et al. 2021

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There is enough clinical evidence that a T-tube use in biliary reconstruction at adult liver transplantation (LT) does not significantly modify the risk of biliary stricture/leak, and it may even sustain infective and metabolic complications. Thus, the policy on T-tube use has been globally changing, with progressive application of more restrictive selection criteria. However, there are no currently standardized indications in such change, and many LT Centers rely only on own experience and routine. A nation-wide survey was conducted among all the 20 Italian adult LT Centers to investigate the current policy on T-tube use. It was found that 20% of Centers completely discontinued the T-tube use, while 25% Centers used it routinely in all LT cases. The remaining 55% of Centers applied a selective policy, based on criteria of technical complexity of biliary reconstruction (72.7%), followed by low-quality graft (63.6%) and high-risk recipient (36.4%). A T-tube use > 50% of annual caseload was not associated with high-volume Center status (> 70 LT per year), an active pediatric or living-donor transplant program, or use of DCD grafts. Only 10/20 (50%) Centers identified T-tube as a potential risk factor for complications other than biliary stricture/leak. In these cases, the suspected pathogenic mechanism comprised bacterial colonization (70%), malabsorption (70%), interruption of the entero-hepatic bile-acid cycle (50%), biliary inflammation due to an indwelling catheter (40%) and gut microbiota changes (40%). In conclusion, the prevalence of T-tube use among the Italian LT Centers is still relatively high, compared to the European trend (33%), and the potential detrimental effect of T-tube, beyond biliary stricture/leak, seems to be somehow underestimated.

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Section: Discussionmentioning

confidence: 99%

An Italian survey on the use of T-tube in liver transplantation: old habits die hard!

et al. 2021

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“…Some authors observed an association between low ICG-PDR values and the onset of EAD after transplantation with a decrease in overall survival [5]. From our previous study based on a cohort of 78 patients, the ICG-PDR on the 1st PO day represents an easy, repeatable, and bedside measurement able to predict EAD and graft survival at 1-and 5-years with a cut-off value of 16%/min [18]. Other authors observed that low ICG-PDR values, respectively < 12.85 and < 9.6%/min, were associated with early post-operative complications and death [5,13,22].…”

Section: Plos Onementioning

confidence: 94%

“…ICG-PDR was assessed by pulse spectrophotometry to provide a real-time picture of a transplanted graft's metabolic function before and after surgery. A detailed explanation of ICG-PDR measurement is reported in our previous publication [18]. To estimate the graft function and recovering/suffering ICG-PDR relative variation rate between T1 and T2 was calculated.…”

Section: Study Protocolmentioning

confidence: 99%

Association between the donor to recipient ICG-PDR variation rate and the functional recovery of the graft after orthotopic liver transplantation: A case series

et al. 2021

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Background Despite current advances in liver transplant surgery, post-operative early allograft dysfunction still complicates the patient prognosis and graft survival. The transition from the donor has not been yet fully understood, and no study quantifies if and how the liver function changes through its transfer to the recipient. The indocyanine green dye plasma disappearance rate (ICG-PDR) is a simple validated tool of liver function assessment. The variation rate between the donor and recipient ICG-PDR still needs to be investigated. Materials and methods Single-center retrospective study. ICG-PDR determinations were performed before graft retrieval (T1) and 24 hours after transplant (T2). The ICG-PDR relative variation rate between T1 and T2 was calculated to assess the graft function and suffering/recovering. Matched data were compared with the MEAF model of graft dysfunction. Objective To investigate whether the variation rate between the donor ICG-PDR value and the recipient ICG-PDR measurement on first postoperative day (POD1) can be associated with the MEAF score. Results 36 ICG-PDR measurements between 18 donors and 18 graft recipients were performed. The mean donor ICG-PDR was 22.64 (SD 6.35), and the mean receiver’s ICG-PDR on 1st POD was 17.68 (SD 6.60), with a mean MEAF value of 4.51 (SD 1.23). Pearson’s test stressed a good, linear inverse correlation between the ICG-PDR relative variation and the MEAF values, correlation coefficient -0.580 (p = 0.012). Conclusion The direct correlation between the donor to recipient ICG-PDR variation rate and MEAF was found. Measurements at T1 and T2 showed an up- or downtrend of the graft performance that reflect the MEAF values.

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“…One study had high applicability concerns in the domain "Participants" (3%) [54]. In the remaining 29 studies (97%), high applicability concerns were observed only in the domain "Outcomes" [11,20,[26][27][28][29]31,[33][34][35][36][37][38][39]41,[43][44][45][46][48][49][50][51][52][53][55][56][57]. According to PROBAST, seven studies included in the ET-DRI analysis were rated low risk of bias, and one was rated high risk of bias [9,10,[20][21][22]32,42,58].…”

Section: Risk Of Bias Assessmentmentioning

confidence: 99%

Prognostic role of the Donor Risk Index, the Eurotransplant Donor Risk Index, and the Balance of Risk score on graft loss after liver transplantation

et al. 2021

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This study aimed to identify cutoff values for donor risk index (DRI), Eurotransplant (ET)-DRI, and balance of risk (BAR) scores that predict the risk of liver graft loss. MEDLINE and Web of Science databases were searched systematically and unrestrictedly. Graft loss odds ratios and 95% confidence intervals were assessed by meta-analyses using Mantel-Haenszel tests with a random-effects model. Cutoff values for predicting graft loss at 3 months, 1 year, and 3 years were analyzed for each of the scores. Measures of calibration and discrimination used in studies validating the DRI and the ET-DRI were summarized. DRI ≥ 1.4 (six studies, n = 35 580 patients) and ET-DRI ≥ 1.4 (four studies, n = 11 666 patients) were associated with the highest risk of graft loss at all time points. BAR > 18 was associated with the highest risk of 3-month and 1-year graft loss (n = 6499 patients). A DRI cutoff of 1.8 and an ET-DRI cutoff of 1.7 were estimated using a summary receiver operator characteristic curve, but the sensitivity and specificity of these cutoff values were low. A DRI and ET-DRI score ≥ 1.4 and a BAR score > 18 have a negative influence on graft survival, but these cutoff values are not well suited for predicting graft loss.

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Indocyanine green dye clearance test: early graft (dys)-function and long-term mortality after liver transplant. Should we continue to use it? An observational study

Cited by 9 publications

References 31 publications

An Italian survey on the use of T-tube in liver transplantation: old habits die hard!

An Italian survey on the use of T-tube in liver transplantation: old habits die hard!

Association between the donor to recipient ICG-PDR variation rate and the functional recovery of the graft after orthotopic liver transplantation: A case series

Prognostic role of the Donor Risk Index, the Eurotransplant Donor Risk Index, and the Balance of Risk score on graft loss after liver transplantation

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