Journal of Gastrointestinal Surgery

, Volume 12, Issue 1, pp 67–72 | Cite as

Indocyanine Green Plasma Disappearance Rate During the Anhepatic Phase of Orthotopic Liver Transplantation

  • Lukas Bruegger
  • Peter Studer
  • Stefan W. Schmid
  • Gunther Pestel
  • Juerg Reichen
  • Christian Seiler
  • Daniel Candinas
  • Daniel InderbitzinEmail author
SSAT poster


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.


Indocyanine 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.


  1. 1.
    Shoup M, Gonen M, D’Angelica M, Jarnagin WR, DeMatteo RP, Schwartz LH, Tuorto S, Blumgart LH, Fong Y. Volumetric analysis predicts hepatic dysfunction in patients undergoing major liver resection. J Gastrointest Surg 2003;7:325–330.PubMedCrossRefGoogle Scholar
  2. 2.
    Leevy CM, Mendenhall CL, Lesko W, Howard MM. Estimation of hepatic blood flow with indocyanine green. J Clin Invest 1962;41:1169–1179.PubMedCrossRefGoogle Scholar
  3. 3.
    Tygstrup N. Determination of the hepatic galactose elimination capacity after a single intravenous injection in man: the reproducibility and the influence of uneven distribution. Acta Physiol Scand 1963;58:162–172.PubMedCrossRefGoogle Scholar
  4. 4.
    Paumgartner G. The handling of indocyanine green by the liver. Schweiz Med Wochenschr 1975;105:1–30.PubMedGoogle Scholar
  5. 5.
    Skak C, Keiding S. Methodological problems in the use of indocyanine green to estimate hepatic blood flow and ICG clearance in man. Liver 1987;7:155–162.PubMedGoogle Scholar
  6. 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
  7. 7.
    Uusaro A, Ruokonen E, Takala J. Estimation of splanchnic blood flow by the Fick principle in man and problems in the use of indocyanine green. Cardiovasc Res 1995;30:106–112.PubMedCrossRefGoogle Scholar
  8. 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
  9. 9.
    Gottlieb ME, Stratton HH, Newell JC, Shah DM. Indocyanine green. Its use as an early indicator of hepatic dysfunction following injury in man. Arch Surg 1984;119:264–268.PubMedGoogle Scholar
  10. 10.
    Kimura S, Yoshioka T, Shibuya M, Sakano T, Tanaka R, Matsuyama S. Indocyanine green elimination rate detects hepatocellular dysfunction early in septic shock and correlates with survival. Crit Care Med 2001;29:1159–1163.PubMedCrossRefGoogle Scholar
  11. 11.
    Sakka SG, Reinhart K, Meier-Hellmann A. Prognostic value of the indocyanine green plasma disappearance rate in critically ill patients. Chest 2002;122:1715–1720.PubMedCrossRefGoogle Scholar
  12. 12.
    Diaz S, Perez-Pena J, Sanz J, Olmedilla L, Garutti I, Barrio JM. Haemodynamic monitoring and liver function evaluation by pulsion cold system Z-201 (PCS) during orthotopic liver transplantation. Clin Transplant 2003;17:47–55.PubMedCrossRefGoogle Scholar
  13. 13.
    Jochum C, Beste M, Penndorf V, Farahani MS, Testa G, Nadalin S, Malago M, Broelsch CE, Gerken G. Quantitative liver function tests in donors and recipients of living donor liver transplantation. Liver Transpl 2006;12:544–549.PubMedCrossRefGoogle Scholar
  14. 14.
    Hori T, Iida T, Yagi S, Taniguchi K, Yamamoto C, Mizuno S, Yamagiwa K, Isaji S, Uemoto S. K(ICG) value, a reliable real-time estimator of graft function, accurately predicts outcomes in adult living-donor liver transplantation. Liver Transpl 2006;12:605–613.PubMedCrossRefGoogle Scholar
  15. 15.
    Shinohara H, Tanaka A, Kitai T, Yanabu N, Inomoto T, Satoh S, Hatano E, Yamaoka Y, Hirao K. Direct measurement of hepatic indocyanine green clearance with near-infrared spectroscopy: separate evaluation of uptake and removal. Hepatology 1996;23:137–144.PubMedCrossRefGoogle Scholar
  16. 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
  17. 17.
    Sakka SG, Reinhart K, Meier-Hellmann A. Comparison of invasive and noninvasive measurements of indocyanine green plasma disappearance rate in critically ill patients with mechanical ventilation and stable hemodynamics. Intensive Care Med 2000;26:1553–1556.PubMedCrossRefGoogle Scholar
  18. 18.
    Tsubono T, Todo S, Jabbour N, Mizoe A, Warty V, Demetris AJ, Starzl TE. Indocyanine green elimination test in orthotopic liver recipients. Hepatology 1996;24:1165–1171.PubMedCrossRefGoogle Scholar
  19. 19.
    Inderbitzin D, Muggli B, Ringger A, Beldi G, Gass M, Gloor B, Uehlinger D, Regli B, Reichen J, Candinas D. Molecular absorbent recirculating system for the treatment of acute liver failure in surgical patients. J Gastrointest Surg 2005;9:1155–1161.PubMedCrossRefGoogle Scholar
  20. 20.
    Schindl MJ, Redhead DN, Fearon KC, Garden OJ, Wigmore SJ. The value of residual liver volume as a predictor of hepatic dysfunction and infection after major liver resection. Gut 2005;54:289–296.PubMedCrossRefGoogle Scholar
  21. 21.
    Heemann U, Treichel U, Loock J, Philipp T, Gerken G, Malago M, Klammt S, Loehr M, Liebe S, Mitzner S, Schmidt R, Stange J. Albumin dialysis in cirrhosis with superimposed acute liver injury: a prospective, controlled study. Hepatology 2002;36:949–958.PubMedGoogle Scholar
  22. 22.
    Sen S, Williams R, Jalan R. Emerging indications for albumin dialysis. Am J Gastroenterol 2005;100:468–475.PubMedCrossRefGoogle Scholar
  23. 23.
    Stehr A, Ploner F, Traeger K, Theisen M, Zuelke C, Radermacher P, Matejovic M. Plasma disappearance of indocyanine green: a marker for excretory liver function? Intensive Care Med 2005;31:1719–1722.PubMedCrossRefGoogle Scholar
  24. 24.
    Fujita Y, Sakai T, Ohsumi A, Takaori M. Effects of hypocapnia and hypercapnia on splanchnic circulation and hepatic function in the beagle. Anesth Analg 1989;69:152–157.PubMedCrossRefGoogle Scholar
  25. 25.
    Birnbaum J, Lehmann C, Taymoorian K, Krausch D, Wauer H, Grundling M, Spies C, Kox WJ. [The effect of dopexamine and iloprost on plasma disappearance rate of indocyanine green in patients in septic shock]. Anaesthesist 2003;52:1014–1019.PubMedCrossRefGoogle Scholar
  26. 26.
    Pomier-Layrargues G, Huet PM, Villeneuve JP, Marleau D. Effect of portacaval shunt on drug disposition in patients with cirrhosis. Gastroenterology 1986;91:163–167.PubMedGoogle Scholar
  27. 27.
    Landsman ML, Kwant G, Mook GA, Zijlstra WG. Light-absorbing properties, stability, and spectral stabilization of indocyanine green. J Appl Physiol 1976;40:575–583.PubMedGoogle Scholar
  28. 28.
    Ishihara H, Matsui A, Muraoka M, Tanabe T, Tsubo T, Matsuki A. Detection of capillary protein leakage by indocyanine green and glucose dilutions in septic patients. Crit Care Med 2000;28:620–626.PubMedCrossRefGoogle Scholar
  29. 29.
    Ott P, Bass L, Keiding S. The kinetics of continuously infused indocyanine green in the pig. J Pharmacokinet Biopharm 1996;24:19–44.PubMedCrossRefGoogle Scholar
  30. 30.
    Burczynski FJ, Pushka KL, Sitar DS, Greenway CV. Hepatic plasma flow: accuracy of estimation from bolus injections of indocyanine green. Am J Physiol 1987;252:H953–H962.PubMedGoogle Scholar
  31. 31.
    Ernest D, Belzberg AS, Dodek PM. Distribution of normal saline and 5% albumin infusions in septic patients. Crit Care Med 1999;27:46–50.PubMedCrossRefGoogle Scholar
  32. 32.
    Margarson MP, Soni NC. Changes in serum albumin concentration and volume expanding effects following a bolus of albumin 20% in septic patients. Br J Anaesth 2004;92:821–826.PubMedCrossRefGoogle Scholar
  33. 33.
    Ibla JC, Khoury J. Methods to assess tissue permeability. Methods Mol Biol 2006;341:111–117.PubMedGoogle Scholar

Copyright information

© The Society for Surgery of the Alimentary Tract 2007

Authors and Affiliations

  • Lukas Bruegger
    • 1
  • Peter Studer
    • 1
  • Stefan W. Schmid
    • 1
  • Gunther Pestel
    • 2
  • Juerg Reichen
    • 3
  • Christian Seiler
    • 1
  • Daniel Candinas
    • 1
  • Daniel Inderbitzin
    • 1
    Email author
  1. 1.Department of Visceral and Transplant SurgeryUniversity Hospital BernBernSwitzerland
  2. 2.Institute of AnaesthesiologyUniversity Hospital BernBernSwitzerland
  3. 3.Institute of Clinical PharmacologyUniversity Hospital BernBernSwitzerland

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