Indocyanine green elimination test in orthotopic liver recipients



Objective: To determine its predictive capability on graft quality and resultant clinical outcome, the indocyanine green (ICG) elimination test was performed by a spectrophotometric method and a noninvasive finger-piece method with 50 orthotopic liver transplantations. Background: Early detection of poor-functioning hepatic grafts is one of the most important issues in liver transplantation, but no reliable methods exist. Methods: The ICG test was performed after 50 orthotopic liver transplantations on postoperative days 1, 3, and 7. Indocyanine green elimination constants (KICG) were measured by both a standard spectrophotometric analysis (KICG-B) and by a finger-piece method (KICG-F). The patients were followed for a minimum of 3 months after transplantation. Results of ICG tests were correlated with various clinical determinations. Results: Twelve of the 50 grafts were lost within three months, of which 7 were related to graft failure. Multivariate analysis using the Cox proportional hazard model revealed that KICG on postoperative day 1 was a better predictor of liver- related graft outcome than any of the conventional liver function tests. Furthermore, KICG values showed significant correlation with the severity of preservation injury, longer intensive care unit (ICU) and hospital stay, prolonged liver dysfunction, and septic complications. Correlation of KICG values by the spectrophotometric method with those by the finger-piece method was highly satisfactory in the grafts that had KICG-B <0.15 min-1 (y = 0.868x -0.011, r = .955). Conclusion: The ICG elimination test, conducted spectrophotometrically or optically on the day after liver transplantation, is a reliable indicator of graft quality and subsequent graft outcome early after liver transplantation.