Plasma disappearance rate of indocyanine green: A tool to evaluate early graft outcome after liver transplantation

Abstract

Indocyanine green clearance (Cl-ICG) has been used to assess liver function and hepatic blood flow mainly before and after hepatic surgery. Cl-ICG (invasive method) has been reported to be a good marker of early graft function after liver transplantation (LT). The goal of this study was to determine if the indocyanine green plasma disappearance rate (PDR-ICG), measured by a noninvasive technique (LiMON, Impulse Medical System, Munich, Germany), is predictive of complications and graft outcome after LT. From September 2005 to June 2006, 72 LT recipients were included in the study. PDR-ICG was measured daily (from day 0 to day 5 after LT) with a digital sensor after patients were injected with 0.25 mg/kg indocyanine green. A PDR-ICG cutoff level of 12.85%/minute was predictive of the development of a serious postoperative complication. The sequential changes of PDR-ICG enabled us to differentiate 2 groups: (1) patients with early severe complications (hepatic artery thrombosis, primary graft nonfunction, or sepsis) who had a low value of PDR-ICG during the first 5 posttransplantation days (average, 8.8 Ϯ 4.5%/minute) and (2) patients who developed acute rejection and who had a progressive reduction of PDR-ICG between days 0 and 5 (from 25.5 Ϯ 4.8 to 10.3 Ϯ 2.5%/minute; P Ͻ 0.002). In conclusion, after LT, PDR-ICG (a noninvasive technique), measured regularly during the first 5 postoperative days, is a safe technique that can predict early postoperative complications.

Indocyanine green kinetics to assess liver function: Ready for a clinical dynamic assessment in major liver surgery?

“…Levesque et al [56,57] using LiMON (Pulsion Medical System, Germany) from POD 1 to POD 5 defined an ICGPDR value able to predict early postoperative complications. In a first study [56] , in a series of 70 consecutive procedures, the transplanted patients were divided in two groups according to the early outcome: In the group of patients who did well, had immediate good graft function, favourable postoperative course and positive outcome, ICGPDR was 24.4% ± 6.8% per minute.…”

“…In a first study [56] , in a series of 70 consecutive procedures, the transplanted patients were divided in two groups according to the early outcome: In the group of patients who did well, had immediate good graft function, favourable postoperative course and positive outcome, ICGPDR was 24.4% ± 6.8% per minute. Instead, the patients who had postoperative complications were retrospectively subdivided into two subgroups: The first group was composed by subjects who experienced PGNF, HAT, and hemorrhagic or septic shock (early complications); the second included patients who had rejection (late complications).…”

The Role of Organic Anion Transporters in Diagnosing Liver Diseases by Magnetic Resonance Imaging

“…The dye is likely to exit without transformation through hMRP2. The vascular clearance of ICG correlates to hepatic function of patients with liver diseases, and ICG finger clips connected via an optical probe can determine the capillary ICG decay over time (de Liguori Carino et al, 2009;Levesque et al, 2009). Another application of ICG in the operating room is to better visualize the resection limits of hepatocellular carcinomas using a fluorescence camera (Gotoh et al, 2009).…”

Evaluation of early liver graft performance by the indocyanine green plasma disappearance rate

“…A recent issue of Liver Transplantation presented 2 novel studies, 1,2 both of which applied the indocyanine green plasma disappearance rate (ICG-PDR) to evaluate early graft performance after deceased donor liver transplantation (LT). We read both articles with particular interest as our group has been intensively working in the same field.…”

“…In the second study, Levesque et al 1 daily determined ICG-PDR in 72 liver recipients during the initial 5 days after LT. This study was undertaken to investigate the predictive value of ICG-PDR for early postoperative complications.…”