Indocyanine Green Elimination Test in Orthotopic Liver Recipients

Abstract

perioperative period is needed; however, conventional liver Objective. To determine its predictive capability on function tests have limited reliability 3,4 and the results of graft quality and resultant clinical outcome, the indocyvarious quantitative liver function tests have been conflictanine green (ICG) elimination test was performed by a ing. 5-10spectrophotometric method and a noninvasive fingerRecently, the indocyanine green (ICG) elimination test has piece method with 50 orthotopic liver transplantations.been suggested as a predictor of graft viability and outcome, Background. Early detection of poor-functioning hebut its significance has not been fully clarified. [5][6][7]11,12 The patic grafts is one of the most important issues in liver primary goal of this study was to determine whether the ICG transplantation, but no reliable methods exist. Methods.elimination test can predict graft viability and outcome in The ICG test was performed after 50 orthotopic liver the early postoperative period. The secondary goal of this transplantations on postoperative days 1, 3, and 7. Indostudy was to evaluate the applicability of a new noninvasive cyanine green elimination constants (K ICG ) were meaoptical finger-piece method 13 against the conventional specsured by both a standard spectrophotometric analysis trophotometric method for ICG determination. 14 Median cold ischemia elimination test, conducted spectrophotometrically or time of the liver was 12.1 hours, ranging from 7.6 to 25.0 hours. optically on the day after liver transplantation, is a reli-Recipient hepatectomy and liver replacement were performed by the able indicator of graft quality and subsequent graft out-standard technique in 30 cases and by the piggyback method in 20 come early after liver transplantation. (HEPATOLOGY cases. 15 Median warm ischemia time of the graft was 50 minutes, ranging from 28 to 68 minutes. 1996;24:1165-1171.) Postoperative ManagementDespite significant improvements in patient outcome after Postoperative immunosuppression was with tacrolimus and steorthotopic liver transplantation, primary nonfunctioning roids. The rationale for dose adjustment of these agents and suppleand/or poor functioning grafts in the immediate postoperative mentary administration of steroids, azathioprine, or OKT3 have been period remain an important problem.1,2 A reliable method to described elsewhere.

Hepatocyte-Like Cells Derived from Human Amniotic Epithelial Cells Can Be Encapsulated Without Loss of Viability or Function In Vitro

“…Collectively, while these data suggest that bile acid is synthesized and secreted, it would be important to confirm the presence of bile acids via HPLC analysis. Uptake and efflux of ICG is clinically used to evaluate liver functions [38,39]. The monolayer HLC showed uptake of ICG and complete efflux occurred within 24 h. A similar profile in the uptake and efflux of ICG was also seen with the encapsulated HLC.…”

Intraoperative hemodynamics and liver function in adult-to-adult living liver donors

“…Therefore, ICG elimination has been used to evaluate hepatic blood flow and liver function in liver transplant recipients, after partial hepatectomy in rats, and in septic patients with hepatocellular dysfunction. [15][16][17][18] In addition, ICG is an intravascular marker because it binds to plasma proteins rapidly and completely, impeding its extravascular distribution. Thus, it can be used to estimate both blood volume and cardiac output (CO).…”

Molecular adsorbent recirculating system in patients with early allograft dysfunction after liver transplantation: A pilot study

“…21 Previous studies have shown that the ICG elimination test is a reliable indicator of graft quality and subsequent graft outcome early after liver transplantation. [22][23][24] Our threshold value of 10% per minute corresponds to the values predicting far worse outcome in previous studies. [22][23][24] ICG elimination by the liver reflects liver blood flow and microcirculation, hepatocyte energy status, and the inhibition of expression and function of hepatocellular transport systems 21,25 that mediate hepatic uptake and biliary excretion of bile salts and various nonbile salt organic anions such as bilirubin and ICG.…”

“…[22][23][24] Our threshold value of 10% per minute corresponds to the values predicting far worse outcome in previous studies. [22][23][24] ICG elimination by the liver reflects liver blood flow and microcirculation, hepatocyte energy status, and the inhibition of expression and function of hepatocellular transport systems 21,25 that mediate hepatic uptake and biliary excretion of bile salts and various nonbile salt organic anions such as bilirubin and ICG. 25 The marked increase in PDR ICG and decrease of serum bilirubin levels in survivors compared with nonsurvivors in our study is most likely caused by the restoration of energy metabolism and disappearance of ischemia-reperfusion-induced inhibition of expression and function of hepatocellular transport systems in survivors.…”