Indocyanine green elimination test in orthotopic liver recipients.
OBJECTIVE
To determine its predictive capability on graft quality and resultant clinical outcome, the indocyanine green (ICG) elimination test was performed by a spectrophotometric method and a noninvasive finger-piece method with 50 orthotopic liver transplantations.


BACKGROUND
Early detection of poor-functioning hepatic grafts is one of the most important issues in liver transplantation, but no reliable methods exist.


METHODS
The ICG test was performed after 50 orthotopic liver transplantations on postoperative days 1, 3, and 7. Indocyanine green elimination constants (K(ICG)) were measured by both a standard spectrophotometric analysis (K(ICG)-B) and by a finger-piece method (K(ICG)-F). The patients were followed for a minimum of 3 months after transplantation. Results of ICG tests were correlated with various clinical determinations.


RESULTS
Twelve of the 50 grafts were lost within three months, of which 7 were related to graft failure. Multivariate analysis using the Cox proportional hazard model revealed that K(ICG) on postoperative day 1 was a better predictor of liver-related graft outcome than any of the conventional liver function tests. Furthermore, K(ICG) values showed significant correlation with the severity of preservation injury, longer intensive care unit (ICU) and hospital stay, prolonged liver dysfunction, and septic complications. Correlation of K(ICG) values by the spectrophotometric method with those by the finger-piece method was highly satisfactory in the grafts that had K(ICG)-B <0.15 min-1 (y = 0.868x -0.011, r = .955).


CONCLUSIONS
The ICG elimination test, conducted spectrophotometrically or optically on the day after liver transplantation, is a reliable indicator of graft quality and subsequent graft outcome early after liver transplantation.
Department of Surgery, University of Pittsburgh, PA, USA.
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Tsubono
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Todo
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Jabbour
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Mizoe
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Warty
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Demetris
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Starzl
D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007208:Indocyanine Green / Q000493:pharmacokinetics*; D008102:Liver Circulation; D008111:Liver Function Tests; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged
D007208:Indocyanine Green