K(ICG) value, a reliable real-time estimator of graft function, accurately predicts outcomes in adult living-donor liver transplantation.
Reliable monitoring enabling evaluation of graft function is crucial after living-donor liver transplantation (LDLT). A method to identify poor graft function at an early postoperative period would allow opportune intensive clinical management to bring about further improvements in LDLT outcomes. This study assessed the reliability of the indocyanine green (ICG) elimination rate constant (K(ICG)) value as an estimator of graft function and determined the actual temporal changes of K(ICG) after LDLT. K(ICG) values were measured using a noninvasive method in 30 adult recipients up to 28 days after LDLT. The receptor index (LHL15) based on liver scintigraphy, and graft parenchymal damage score based on histopathological findings were evaluated after LDLT and correlated well with simultaneous K(ICG). Thus, K(ICG) measured by noninvasive method was confirmed as accurately evaluating graft function. Changes of K(ICG) after LDLT in recipients with good graft function were maintained, after some falls in the early periods, and had a significant difference compared with those for recipients without good graft function; moreover, there were already significant differences in K(ICG) 24 hours after LDLT. Mean transit time reflecting systemic hemodynamics revealed that recipients without good outcomes fell into an unstable systemic hemodynamic state, and effective hepatic blood flow has a large influence on liver regeneration after LDLT. In conclusion, we suggested that K(ICG) values can predict clinical outcomes at the early postoperative period after LDLT by sharply reflecting the influence of systemic dynamics on splanchnic circulation.
Hori
Tomohide
T
First Department of Surgery, School of Medicine, Mie University, Tsu City, Mie Prefecture, Japan. tomohide@clin.medic.mie-u.ac.jp
Iida
Taku
T
Yagi
Shintaro
S
Taniguchi
Kentaro
K
Yamamoto
Chiduru
C
Mizuno
Shugo
S
Yamagiwa
Kentaro
K
Isaji
Shuji
S
Uemoto
Shinji
S
D000328:Adult; D015415:Biomarkers / Q000097:blood; D001831:Body Temperature; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007208:Indocyanine Green / Q000493:pharmacokinetics*; D016031:Liver Transplantation / Q000276:immunology / Q000401:mortality / Q000502:physiology*; D019520:Living Donors; D008875:Middle Aged; D011184:Postoperative Period; D019275:Radiopharmaceuticals / Q000627:therapeutic use; D016019:Survival Analysis; D013668:Technetium Tc 99m Aggregated Albumin; D016284:Technetium Tc 99m Pentetate; D020858:Tissue and Organ Harvesting / Q000379:methods; D016896:Treatment Outcome
D015415:Biomarkers; D007166:Immunosuppressive Agents; D019275:Radiopharmaceuticals; D013668:Technetium Tc 99m Aggregated Albumin; C070561:technetium Tc 99m DTPA-galactosyl-human serum albumin; D007208:Indocyanine Green; D016284:Technetium Tc 99m Pentetate