Value of Preoperative Indocyanine Green Clearance Test for Predicting Post-Hepatectomy Liver Failure in Noncirrhotic Patients

Abstract

BackgroundLiver failure is the most feared complication following hepatectomy. Post-hepatectomy liver failure (PHLF) is closely related to the remnant liver volume, and functional reserve. There are several methods for predicting PHLF prior to liver resection. The indocyanine green (ICG) clearance test was popularized in patients with hepatocellular cancer (HCC). We aim to demonstrate the value of preoperative ICG clearance measurement via pulse spectrophotometer (LIMON®) in prediction of PHLF in noncirrhotic patients prior to liver resection.Material/MethodsFifty-three noncirrhotic patients who underwent liver resection due to different pathologies were included. Retrospectively collected clinical data, including the preoperative ICG clearance measurements and remnant liver volumes of the patients, were statistically evaluated according to the PHLF criteria of the International Study Group of Liver Surgery.ResultsFour (7.5%) patients with PHLF were observed. There was no significant difference between PHLF and non-PHLF groups regarding ICG clearance measurements with cut-off values of 5% and 9.5%.ConclusionsThe ICG clearance test does not satisfy our expectations in noncirrhotic patients in predicting PHLF. We believe that the ICG clearance test should be reserved for patients with cirrhosis and/or HCC. This test could be an option for noncirrhotic patients with chronic active hepatitis, advanced-grade fatty livers, or for patients who received long-term preoperative chemotherapy, and also for patients who underwent single or multiple sessions of TACE or TARE prior to liver resection. If the routine selection criteria have been fulfilled, there is no further need to perform the ICG clearance test for living liver donors.

A Nomogram Based on Preoperative Inflammatory Indices and ICG-R15 for Prediction of Liver Failure After Hepatectomy in HCC Patients

“…As a quantitative test to assess hepatic blood flow and liver function, the ICG clearance test at 15 minutes (ICG-R15) is now commonly used to evaluate reserved liver function in surgical patients. Moreover, ICG-R15 has been proven to be a reliable predictor of PHLF recently (17,18).…”

Comparison between preoperative two-dimensional shear wave elastography and indocyanine green clearance test for prediction of post-hepatectomy liver failure

“…These results indicated that the efficacy of preoperative ICGR15 for diagnosing ≥ PHLF A was slightly better than that for diagnosing ≥ PHLF B and ≥ PHLF C. However, in general, the diagnostic performance of ICGR15 was not good. This resulted from Cem et al, who demonstrated that the efficacy of the ICG clearance test for PHLF prediction in noncirrhotic patients was unsatisfactory (AUC=0.51, P=0.90) (8). Another study by Wong et al also supported the finding that ICGR15 failed to predict the occurrence of major complications after liver resection (23).…”

“…ICG measurement has high buy-in costs for drug and equipment purchases, and its application is not recommended in patients with thyrotoxicosis or iodine allergy, as ICG contains iodine (7). Furthermore, it has been reported that the value of preoperative ICG clearance testing for predicting PHLF in noncirrhotic patients was not satisfactory (8).…”

Value of contrast-enhanced ultrasound for preoperative assessment of liver reserve function in patients with liver tumors

“…Liver resection is an effective surgical treatment for a broad variety of benign and malignant hepatic tumors, post-hepatectomy liver failure (PHLF) remained the most serious complication and the major cause of mortality after liver resections, particularly in patients with suboptimal liver function due to parenchymal liver disease such as cirrhosis or steatosis[15, 16]. Therefore, it is important to estimate liver reserve function before planning partial resection of the liver in order to predict function of the remnant liver[17].…”