title: Intraoperative ICG plasma disappearance rate helps to predict absence of early postoperative complications after orthotopic liver transplantation.
abstract: Early postoperative complications after orthotopic liver transplantation (OLT) are a common problem in intensive care medicine. Adequate assessment of initial graft function remains difficult, however, plasma disaperance rate of indocyanine green (PDRICG) may have an additional diagnostic and prognostic value in this setting. We retrospectively evaluated the ability of intraoperative PDRICG values to predict absence of early postoperative complications in 62 subjects. PDRICG was measured non-invasively by pulse dye densitometry during surgery and was correlated with initial graft function. At the end of surgery, PDRICG was higher in patients without complications: 24.9 % min(-1) (n = 40) versus 21.0 % min(-1), (n = 22; p = 0.034). An area under the ROC curve (AUROC) for PDRICG was 0.70, while the AUROC for pH, lactate and PT at ICU admission were 0.53, 0.50 and 0.46, respectively. The AUROC of serum bilirubin and PT at postoperative day 5 were 0.68 and 0.49, respectively. The optimal cut-off PDRICG value for predicting absence of development early postoperative complications was determined to be 23.5 % min(-1) with 72.4 % sensitivity and 71.0 % specificity. Intraoperative point-of-care PDRICG measurement during OLT already predicts absence of early postoperative complications, better and earlier than clinically used laboratory parameters.
authors.affiliation: Department of Anesthesiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, PO BOX 30 001, 9700 RB, Groningen, The Netherlands, j.j.vos@umcg.nl.
authors.forename: J J
authors.initials: JJ
authors.lastname: Vos
authors.forename: T W L
authors.initials: TW
authors.lastname: Scheeren
authors.forename: D J
authors.initials: DJ
authors.lastname: Lukes
authors.forename: M T
authors.initials: MT
authors.lastname: de Boer
authors.forename: H G D
authors.initials: HG
authors.lastname: Hendriks
authors.forename: J K G
authors.initials: JK
authors.lastname: Wietasch
mesh_terms: D000465:Algorithms; D001774:Blood Chemical Analysis / Q000379:methods; D042241:Early Diagnosis; D006084:Graft Rejection / Q000097:blood / Q000175:diagnosis* / Q000209:etiology*; D006801:Humans; D007208:Indocyanine Green / Q000032:analysis*; D016031:Liver Transplantation / Q000009:adverse effects*; D008657:Metabolic Clearance Rate; D016343:Monitoring, Intraoperative / Q000379:methods*; D011379:Prognosis; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
chemical_list: D007208:Indocyanine Green