Indocyanine Green Plasma Disappearance Rate During the Anhepatic Phase of Orthotopic Liver Transplantation
- 93 Downloads
Non-invasive pulse spectrophotometry to measure indocyanine green (ICG) elimination correlates well with the conventional invasive ICG clearance test. Nevertheless, the precision of this method remains unclear for any application, including small-for-size liver remnants. We therefore measured ICG plasma disappearance rate (PDR) during the anhepatic phase of orthotopic liver transplantation using pulse spectrophotometry. Measurements were done in 24 patients. The median PDR after exclusion of two outliers and two patients with inconstant signal was 1.55%/min (95% confidence interval [CI] = 0.8–2.2). No correlation with patient age, gender, body mass, blood loss, administration of fresh frozen plasma, norepinephrine dose, postoperative albumin (serum), or difference in pre and post transplant body weight was detected. In conclusion, we found an ICG-PDR different from zero in the anhepatic phase, an overestimation that may arise in particular from a redistribution into the interstitial space. If ICG pulse spectrophotometry is used to measure functional hepatic reserve, the verified average difference from zero (1.55%/min) determined in our study needs to be taken into account.
KeywordsIndocyanine green Pulse spectrophotometry Orthotopic liver transplantation Small-for-size liver remnant
We are indebted to Dr. H. Rieder, Institute of Anaesthesiology, University Hospital Bern, and Hans Saegesser, Institute of Clinical Pharmacology, University Hospital Bern for their skillful technical assistance.
- 6.Kuntz H, Schregel W. Indocyanine green: evaluation of liver function—application in intensive care medicine. In Lewis F, Pfeiffer U, eds. Fiberoptics in Critical Care Monitoring. Berlin: Springer, 1990, pp 57–62.Google Scholar
- 8.Ohwada S, Kawate S, Hamada K, Yamada T, Sunose Y, Tsutsumi H, Tago K, Okabe T. Perioperative real-time monitoring of indocyanine green clearance by pulse spectrophotometry predicts remnant liver functional reserve in resection of hepatocellular carcinoma. Br J Surg 2006;93:339–346.PubMedCrossRefGoogle Scholar
- 16.Faybik P, Krenn CG, Baker A, Lahner D, Berlakovich G, Steltzer H, Hetz H. Comparison of invasive and noninvasive measurement of plasma disappearance rate of indocyanine green in patients undergoing liver transplantation: a prospective investigator-blinded study. Liver Transpl 2004;10:1060–1064.PubMedCrossRefGoogle Scholar