A rapid, reproducible, noninvasive predictor of liver graft survival.
BACKGROUND
Clinical and laboratory criteria are not reliable predictors of deceased donor liver graft quality. Intraoperative assessment of experienced surgeons is the gold standard. Standardizing and quantifying this assessment is especially needed now that regional sharing is the rule. We prospectively evaluated a novel, simple, rapid, noninvasive, quantitative measure of liver function performed before graft procurement.


METHODS
Using a portable, finger-probe-based device, indocyanine green plasma disappearance rates (ICG-PDR) were measured in adult brain-dead donors in the local donor service area before organ procurement. Results were compared with graft function and outcomes. Both donor and recipient teams were blinded to ICG-PDR measurements.


RESULTS
Measurements were performed on 53 consecutive donors. Eleven liver grafts were declined by all centers because of quality; the other 42 grafts were transplanted. Logistic regression analysis showed ICG-PDR to be the only donor variable to be significantly associated with 7-d graft survival. Donor risk index, donor age, and transaminase levels at peak or procurement were not significantly associated with 7-d graft survival.


CONCLUSIONS
We report the successful use of a portable quantitative means of measuring liver function and its association with graft survival. These data warrant further exploration in a variety of settings to evaluate acceptable values for donated liver grafts.
Dumont-UCLA Transplant Center, Division of Liver and Pancreas Transplantation, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California. Electronic address: azarrinpar@mednet.ucla.edu.
Ali
A
Zarrinpar
Dumont-UCLA Transplant Center, Division of Liver and Pancreas Transplantation, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California.
Coney
C
Lee
Dumont-UCLA Transplant Center, Division of Liver and Pancreas Transplantation, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California.
Emily
E
Noguchi
Dumont-UCLA Transplant Center, Division of Liver and Pancreas Transplantation, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California.
Hasan
H
Yersiz
Dumont-UCLA Transplant Center, Division of Liver and Pancreas Transplantation, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California.
Vatche G
VG
Agopian
Dumont-UCLA Transplant Center, Division of Liver and Pancreas Transplantation, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California.
Fady M
FM
Kaldas
Dumont-UCLA Transplant Center, Division of Liver and Pancreas Transplantation, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California.
Douglas G
DG
Farmer
Dumont-UCLA Transplant Center, Division of Liver and Pancreas Transplantation, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California.
Ronald W
RW
Busuttil
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D046148:Donor Selection / Q000379:methods*; D004311:Double-Blind Method; D005260:Female; D005456:Fluorescent Dyes; D006085:Graft Survival; D006801:Humans; D007208:Indocyanine Green; D008099:Liver / Q000502:physiology*; D008111:Liver Function Tests; D016031:Liver Transplantation; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D015203:Reproducibility of Results
D005456:Fluorescent Dyes; D007208:Indocyanine Green
Deceased donor; Indocyanine green; Liver graft assessment; Liver graft utilization; Organ procurement