Evaluation of hepatic perfusion in the liver graft using fluorescence imaging with indocyanine green.
BACKGROUND
Portal vein thrombosis (PVT) after liver transplantation (LT) is one of serious complications and reportedly ranges from 2% to 13%. PVT impairs the blood perfusion to the grafts and causes the graft dysfunction.


METHODS
A 60-year-old female underwent living-donor LT with the left liver graft for end-stage liver disease related to chronic hepatitis C. After reperfusion, Indocyanine green (ICG)-fluorescence imaging was performed to confirm the graft perfusion, which pointed out an insufficient perfusion on the surface of segment 4. Following intraoperative ultrasonography revealed thrombus in the portal vein of segment 4, which was successfully removed by heparinized saline flush.


CONCLUSIONS
The most of patients with PVT developed graft failure and resulted in retransplantation. This enhances the importance of the surveillance for PVT in the postoperative period as well as the intraoperative period. However, the modality to identify PVT during surgery is limited mainly to intraoperative ultrasound. ICG-fluorescence imaging can visualize regions with impaired hepatic perfusion due to PVT in real time during LT in addition to visualization of hepatic flows of reconstructed vessels and evaluation of regions with venous occlusion.


CONCLUSIONS
ICG-fluorescence imaging can be simply performed with single ICG injection and is expected to have potential roles to enhance the safety of LT.
Artificial Organ and Transplantation Surgery Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
Yoshikuni
Y
Kawaguchi
Artificial Organ and Transplantation Surgery Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan. Electronic address: nakamats-tky@umin.ac.jp.
Nobuhisa
N
Akamatsu
Artificial Organ and Transplantation Surgery Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
Takeaki
T
Ishizawa
Artificial Organ and Transplantation Surgery Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
Junichi
J
Kaneko
Artificial Organ and Transplantation Surgery Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
Junichi
J
Arita
Artificial Organ and Transplantation Surgery Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
Yoshihiro
Y
Sakamoto
Artificial Organ and Transplantation Surgery Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
Kiyoshi
K
Hasegawa
Artificial Organ and Transplantation Surgery Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan. Electronic address: KOKUDO-2SU@h.u-tokyo.ac.jp.
Norihiro
N
Kokudo
Fluorescence imaging technique; Indocyanine green; Living-donor liver transplantation; Portal vein thrombosis