title: How do transplant surgeons accomplish optimal portal venous flow during living-donor liver transplantation? Noninvasive measurement of indocyanine green elimination rate.
abstract: BACKGROUND
  Balancing donor safety and graft volume is difficult. We previously reported that intentional modulation of portal venous pressure (PVP) during living-donor liver transplantation (LDLT) is crucial to overcoming problems with small-for-size grafts; however, detailed studies of portal venous flow (PVF) and a reliable parameter are still required.
  
  
  METHODS
  The elimination rate (k) of indocyanine green (ICG) was measured in 49 adult LDLT recipients. PVP was controlled during LDLT, with a target of <20 mm Hg. ICG reflects hepatocyte volume and effective PVF. The kICG value is divided by the graft weight to calculate PVF. Recipients were divided into 2 groups: those with severe and/or fatal complications within 1 month after LDLT and those without.
  
  
  RESULTS
  Survival rates and postoperative profiles were significantly different between the 2 groups. Univariate analysis showed significant differences in ABO blood group, final PVP, final kICG, and the final kICG/graft weight value; however, multivariate analysis showed that only the kICG/graft weight value was significant. The cutoff level for the final kICG/graft weight value for predicting successful LDLT was 3.1175 × 10(-4)/g.
  
  
  CONCLUSIONS
  Accurate evaluation and monitoring of optimal PVF during LDLT should overcome the use of small-for-size grafts and improve donor safety and recipient outcomes.
authors.affiliation: 1Kyoto University Hospital, Kyoto, Japan.
authors.forename: Tomohide
authors.initials: T
authors.lastname: Hori
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Ogura
authors.forename: Shintaro
authors.initials: S
authors.lastname: Yagi
authors.forename: Taku
authors.initials: T
authors.lastname: Iida
authors.forename: Kentaro
authors.initials: K
authors.lastname: Taniguchi
authors.forename: Walid M
authors.initials: WM
authors.lastname: El Moghazy
authors.forename: Mohammed Saied
authors.initials: MS
authors.lastname: Hedaya
authors.forename: Hajime
authors.initials: H
authors.lastname: Segawa
authors.forename: Kohei
authors.initials: K
authors.lastname: Ogawa
authors.forename: Takayuki
authors.initials: T
authors.lastname: Kogure
authors.forename: Shinji
authors.initials: S
authors.lastname: Uemoto
mesh_terms: D001707:Biopsy, Needle; D004396:Coloring Agents / Q000493:pharmacokinetics*; D005260:Female; D006085:Graft Survival; D006439:Hemodynamics; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods; D007208:Indocyanine Green / Q000493:pharmacokinetics*; D016031:Liver Transplantation; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D017082:Portal Pressure; D011169:Portal Vein / Q000601:surgery*; D011183:Postoperative Complications; D012307:Risk Factors; D015996:Survival Rate
chemical_list: D004396:Coloring Agents; D007208:Indocyanine Green
keywords: graft/recipient body-weight ratio; indocyanine green; portal hypertension; portal pressure; small-for-size