title: Early Measurement of Indocyanine Green Clearance Accurately Predicts Short-Term Outcomes After Liver Transplantation.
abstract: BACKGROUND
  There are no accurate tools to predict short-term mortality or the need for early retransplantation after liver transplantation (LT). A noninvasive measurement of indocyanine green clearance, the plasma disappearance rate (PDR), has been associated with initial graft function.
  
  
  METHODS
  We evaluated the ability of PDR to predict early mortality or retransplantation after LT. In this observational prospective study, 332 LT were analyzed. Donor, recipient, and intraoperative data were investigated. The ensuing score was prospectively evaluated in a validation cohort of 77 patients.
  
  
  RESULTS
  Thirty-three patients reached the main endpoint. By multivariate analysis, the only independent predictors of the endpoint were PDR (odds ratio [OR], 0.85; 95% confidence interval, 0.79-0.92) and international normalized ratio (OR, 1.45; 95% confidence interval, 1.17-1.82). A risk score weighted by the OR was built using cutoff values of 2.2 or greater for international normalized ratio (1 point) and less than 10%/min for PDR (2 points). Four categories (0 to 3) were possible. The risk of early death or retransplantation was associated with the score (0, 4.4%; 1, 6.5%; 2, 12%; and 3, 50%; χ for trend, P < 0.001). The score was also associated with duration of mechanical ventilation and intensive care unit stay. The score had a good diagnostic performance in the validation cohort (sensitivity, 60%; specificity, 95.5%; positive predictive value, 66.7%; negative predictive value, 94.1%).
  
  
  CONCLUSIONS
  A simple score obtained within the first day after LT predicts short-term survival and need for retransplantation and may prove useful when selecting diagnostic and therapeutic strategies.
authors.affiliation: 1 Liver Transplant Unit, Hospital Universitario Gregorio Marañón de Madrid, Madrid, Spain. 2 Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain. 3 Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain. 4 Centro de Investigación Biomédica en Red en el Área temática de Enfermedades Hepáticas y Digestivas, Barcelona, Spain.
authors.forename: Luis
authors.initials: L
authors.lastname: Olmedilla
authors.forename: Cristina J
authors.initials: CJ
authors.lastname: Lisbona
authors.forename: José M
authors.initials: JM
authors.lastname: Pérez-Peña
authors.forename: José A
authors.initials: JA
authors.lastname: López-Baena
authors.forename: Ignacio
authors.initials: I
authors.lastname: Garutti
authors.forename: Magdalena
authors.initials: M
authors.lastname: Salcedo
authors.forename: Javier
authors.initials: J
authors.lastname: Sanz
authors.forename: Manuel
authors.initials: M
authors.lastname: Tisner
authors.forename: José M
authors.initials: JM
authors.lastname: Asencio
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Fernández-Quero
authors.forename: Rafael
authors.initials: R
authors.lastname: Bañares
mesh_terms: D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D004396:Coloring Agents / Q000008:administration & dosage / Q000493:pharmacokinetics*; D005260:Female; D006801:Humans; D007208:Indocyanine Green / Q000008:administration & dosage / Q000493:pharmacokinetics*; D007362:Intensive Care Units; D007902:Length of Stay; D008111:Liver Function Tests; D016031:Liver Transplantation / Q000009:adverse effects* / Q000401:mortality; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011183:Postoperative Complications / Q000097:blood / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012086:Reoperation; D015203:Reproducibility of Results; D012121:Respiration, Artificial; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D004396:Coloring Agents; D007208:Indocyanine Green