title: Predicting immunosuppressant dosing in the early postoperative period with noninvasive indocyanine green elimination following orthotopic liver transplantation.
abstract: Twenty adult patients undergoing orthotopic liver transplantation (OLT) were enrolled in this study, with the noninvasive indocyanine green plasma disappearance rate (ICG-PDR) measured both during and after OLT to assess the relationship between ICG-PDR and the ability of patients to achieve therapeutic postoperative tacrolimus immunosuppressant blood levels. Liver function was determined at both 2 and 18 hours post reperfusion with the ICG-PDR k value (1/min). Postoperative standard serum measures of liver function as well as liver biopsies were also collected and analyzed. The median ICG-PDR k value for the study group at 2 hours post reperfusion was 0.20 (0.16, 0.27), whereas at 18 hours post reperfusion, it was 0.22 (0.18, 0.35). The median change in the k value between the two ICG-PDR measurements was 0.05 (-0.02, 0.07) with P = 0.02. There was an interaction between the postoperative day 1 (18 hours post reperfusion) ICG-PDR k value and the linear increase in the tacrolimus blood level, such that the greater the k value was, the more gradual the observed rise was in tacrolimus over time [that is, the longer it took to achieve a therapeutic blood level (>12 ng/mL), P = 0.003]. Of the 16 patients that received tacrolimus, comparable dosing on a per kilogram body weight basis was observed. Also, no significant association between ICG-PDR k values and postoperative liver biopsy results was seen. This study demonstrates that the ICG-PDR measurement is a modality with the potential to assist in achieving adequate blood levels of tacrolimus following OLT.
authors.affiliation: Department of General Anesthesiology, Cleveland Clinic, Cleveland, OH 44195, USA. parkerb1@ccf.org
authors.forename: Brian M
authors.initials: BM
authors.lastname: Parker
authors.forename: Jacek B
authors.initials: JB
authors.lastname: Cywinski
authors.forename: Joan M
authors.initials: JM
authors.lastname: Alster
authors.forename: Samuel A
authors.initials: SA
authors.lastname: Irefin
authors.forename: Marc
authors.initials: M
authors.lastname: Popovich
authors.forename: Michael
authors.initials: M
authors.lastname: Beven
authors.forename: John J
authors.initials: JJ
authors.lastname: Fung
mesh_terms: D001706:Biopsy; D004396:Coloring Agents / Q000493:pharmacokinetics*; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000175:diagnosis / Q000188:drug therapy* / Q000378:metabolism; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D007208:Indocyanine Green / Q000493:pharmacokinetics*; D017093:Liver Failure / Q000175:diagnosis / Q000378:metabolism / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D016559:Tacrolimus / Q000008:administration & dosage*
chemical_list: D004396:Coloring Agents; D007166:Immunosuppressive Agents; D007208:Indocyanine Green; D016559:Tacrolimus