Predictive Value of Indocyanine Green Plasma Disappearance Rate on Liver Function and Complications After Liver Transplantation

Abstract

BackgroundThe aim of this study was to investigate the correlation between indocyanine green plasma disappearance rate (ICG-PDR) and allograft function as well as postoperative complications after liver transplantation.Material/MethodsIn this prospective study, 115 cases of adult liver transplantation performed from 1 June 2016 to 1 December 2016 were enrolled. These 115 patients were divided into a group of PDR <18%/min (50 cases) and a group of PDR ≥18%/min (65 cases). The rates of liver recovery, postoperative complications, and survival were compared between these 2 groups.ResultAmong the total of 115 patients, 111 patients recovered well and were discharged, whereas 4 patients died during the first month after the operation. Between the 2 groups, significant differences were observed in terms of the model for end-stage liver disease (MELD) score, intraoperative bleeding volume, and the level of hemoglobin (Hb), pre-albumin (PA) and total bilirubin (TB) the first week after the operation. Overall, the incidence of hepatic arterial complications and pneumonia was much higher in the PDR<18%/min group (P<0.05).ConclusionsThe early postoperative value of ICG-PDR was closely related to graft function and could act as a good predictor for the incidence of postoperative arterial complications.

Advantages of using indocyanine green in liver transplantation: a narrative review

“…Additionally, they found that with a normal value of ICG-PDR, angiography was unnecessary in emergency situations, suggesting that ICG-PDR may be more sensitive than angiography (62). Sun et al also investigated ICG-PDR in 115 LT patients, and found that hepatic arterial complications and rates of pneumonia were higher in the ICG-PDR <18%/minute group compared to a control (63). Collectively, these studies show that the ICG clearance rate can provide a reliable, convenient, and low-cost postoperative test to predict mortality and surgical complications.…”

Management of Patients with Liver Transplantation in ICU

“…Its removal from the blood depends on the hepatic blood flow, parenchymal cell function, and biliary excretion. It is expressed as half-life time, blood clearance, or plasma disappearance rate (ICG-PDR) smaller than 15% associated with a higher rate of primary dysfunction [50]. The bedside ultrasound imaging methods with hepatic blood vessel Doppler examination are usually performed on the day of surgery or on the first postoperative one in order to evaluate the patency of the hepatic artery, the portal vein, and the hepatic vein.…”

Avaliação do comportamento da pressão intra-abdominal e da incidência de hipertensão intra-abdominal em pacientes submetidos a transplante de fígado

“…Diante do potencial risco para disfunção de órgãos provenientes de doadores cadavéricos, torna-se necessária a avaliação do enxerto com o intuito de predizer a incidência de complicações pós-operatórias nos seus respectivos receptores 58 .…”

“…Por mais que haja escalas de pontuação para avaliação hepática como Child-Pugh e MELD, com a finalidade de diagnosticar hepatopatias avançadas e priorizá-las de acordo com a gravidade dos receptores antes do transplante, falta sensibilidade e especificidade para ambas no contexto pósoperatório, sem aplicação prática no caso de avaliação da função do enxerto 58 .…”

“…Diante destas limitações, a taxa de eliminação do verde de indocianina, do inglês ICG, vem sendo amplamente utilizada para medir a função e o fluxo sanguíneo hepáticos desde 1961 60 . A eliminação deste corante se correlaciona intimamente com a função intrínseca do fígado, bem como com a perfusão sanguínea deste órgão 59 , refletindo a função fisiológica hepatocitária assim como o número total de células hepáticas reativas, tratando-se de uma ferramenta diagnóstica para avaliar a reserva funcional do fígado 58 .…”