Non-invasive ICG-clearance: a useful tool for the management of hepatic artery thrombosis following liver transplantation.
BACKGROUND
The clinical presentation of hepatic artery thrombosis (HAT) post-liver transplantation (LT) varies considerably. Doppler ultrasonography (Doppler US) is the first line investigation, with a diagnostic sensitivity for HAT as high as 92%. Because indocyanine green (ICG) elimination from the blood depends among other factors on the hepatic blood flow, we hypothesized that plasma disappearance rate of indocyanine green (PDR-ICG) can be influenced by the flow in the hepatic artery. Thus, we evaluated the role of PDR-ICG measurement in HAT diagnosis in post-LT patients.


METHODS
Fourteen liver transplant patients with no visible flow in the hepatic artery (Doppler US) were identified. Of the 14, seven patients had HAT confirmed by CT-angiography. The PDR-ICG measurement, an investigation routinely used in our center, was performed in all 14 patients.


RESULTS
The PDR-ICG in patients with HAT was significantly lower than in patients without HAT (5.8 ± 4.3 vs. 23.8 ± 7.4%/min, p= 0.0009). In patients with HAT, after the revascularization, the PDR-ICG value increased (5.8 ± 4.3 vs. 15.6 ± 3.5%/min, p = 0.006).


CONCLUSIONS
The ICG elimination may be an adjunct diagnostic tool in the management of patients with suspected HAT following LT.
Levesque
E
E
AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Villejuif, France.
Hoti
E
E
Azoulay
D
D
Adam
R
R
Samuel
D
D
Castaing
D
D
Saliba
F
F
D000328:Adult; D004396:Coloring Agents / Q000493:pharmacokinetics; D005260:Female; D006084:Graft Rejection / Q000517:prevention & control; D006085:Graft Survival; D006499:Hepatic Artery / Q000473:pathology*; D006801:Humans; D007208:Indocyanine Green / Q000493:pharmacokinetics; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D013927:Thrombosis / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D014018:Tissue Distribution; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler
D004396:Coloring Agents; D007208:Indocyanine Green