Early noninvasive measurement of the indocyanine green plasma disappearance rate accurately predicts early graft dysfunction and mortality after deceased donor liver transplantation.
Early diagnosis of graft dysfunction in liver transplantation is essential for taking appropriate action. Indocyanine green clearance is closely related to liver function and can be measured noninvasively by spectrophotometry. The objectives of this study were to prospectively analyze the relationship between the indocyanine green plasma disappearance rate (ICGPDR) and early graft function after liver transplantation and to evaluate the role of ICGPDR in the prediction of severe graft dysfunction (SGD). One hundred seventy-two liver transplants from deceased donors were analyzed. Ten patients had SGD: 6 were retransplanted, and 4 died while waiting for a new graft. The plasma disappearance rate was measured 1 hour (PDRr60) and within the first 24 hours (PDR1) after reperfusion, and it was significantly lower in the SGD group. PDRr60 and PDR1 were excellent predictors of SGD. A threshold PDRr60 value of 10.8%/minute and a PDR1 value of 10%/minute accurately predicted SGD with areas under the receiver operating curve of 0.94 (95% confidence interval, 0.89-0.97) and 0.96 (95% confidence interval, 0.92-0.98), respectively. In addition, survival was significantly lower in patients with PDRr60 values below 10.8%/minute (53%, 47%, and 47% versus 95%, 94%, and 90% at 3, 6, and 12 months, respectively) and with PDR1 values below 10%/minute (62%, 62%, and 62% versus 94%, 92%, and 88%). In conclusion, very early noninvasive measurement of ICGPDR can accurately predict early severe graft dysfunction and mortality after liver transplantation.
Department of Anesthesiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain. lolmedilla.hgugm@salud.madrid.org
Luis
L
Olmedilla
José María
JM
Pérez-Peña
Cristina
C
Ripoll
Ignacio
I
Garutti
Roberto
R
de Diego
Magdalena
M
Salcedo
Consuelo
C
Jiménez
Rafael
R
Bañares
D000328:Adult; D005260:Female; D006084:Graft Rejection / Q000097:blood*; D006085:Graft Survival; D006801:Humans; D007208:Indocyanine Green / Q000493:pharmacokinetics*; D008107:Liver Diseases / Q000097:blood* / Q000628:therapy; D016031:Liver Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D015424:Reperfusion; D013997:Time Factors; D014019:Tissue Donors; D016896:Treatment Outcome
D007208:Indocyanine Green