Abstract
Background/Purpose
In living-donor liver transplantation (LDLT), hepatic arterial thrombosis and portal venous thrombosis are critical problems that can result in graft loss. Only intraoperative Doppler ultrasound (IDUS) is able to evaluate blood flow in the reconstructed vessels. The aim of this study was to evaluate the utility of a newly developed fluorescence imaging technique using indocyanine green (ICG) for visualizing reconstructed vessels.
Methods
In three patients who had undergone LDLT, IDUS was performed after reconstruction of the portal vein and hepatic artery. Fluorescence images were then recorded, using a SPY system (Novadeq Technologies), which employs ICG as a fluorescent imaging medium activated by light. The ICG (3.75 mg) was injected intravenously, then, 10 s later, the images were recorded for 30 s (first photographic recording). Two minutes later, the same procedure was repeated (second photographic recording), and 40 min later, images were obtained without injection of ICG (third photographic recording).
Results
After portal venous reconstruction, IDUS demonstrated a nonphasic and continuous waveform, with a mean velocity of 52.1 cm/s and a mean portal blood flow volume of 69.5 ml/s per kg. After hepatic arterial reconstruction, a pulsatile waveform with a mean peak systolic velocity of 52.4 cm/s and a mean resistance index of 0.76 was obtained. The first photographic recording clearly visualized the blood flow in the reconstructed hepatic artery, without kinking or stenosis, in all three patients. The second photographic recording visualized the flow in the portal vein without stenosis, kinking, or stagnation. The third photographic recording demonstrated the excretion of ICG into bile, thus confirming bile production by the grafts.
Conclusions
Fluorescence imaging can clearly visualize the reconstructed hepatic artery and portal vein and demonstrate the production of bile by a transplanted liver graft. A combination of IDUS and the new system can guarantee the patency of the reconstructed vessels.
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References
K Tanaka T Kiuchi (2002) ArticleTitleLiving-donor liver transplantation in the new decade: perspective from the twentieth to the twenty-first century J Hepatobiliary Pancreat Surg 9 218–22 Occurrence Handle12140610
Y Sugawara M Makuuchi J Kaneko T Ohkubo Y Matsui H Imamura et al. (2003) ArticleTitleLiving-donor liver transplantation in adults: Tokyo University experience J Hepatobiliary Pancreat Surg 10 1–4 Occurrence Handle12918450
DJ Lomas PD Britton P Farman R Coulden A Egan GN Jamieson et al. (1992) ArticleTitleDuplex Doppler ultrasound for the detection of vascular occlusion following liver transplantation in children Clin Radiol 46 38–42 Occurrence Handle10.1016/S0009-9260(05)80032-7 Occurrence Handle1:STN:280:By2A2Mvitlw%3D Occurrence Handle1643781
T Kok PMJG Peeters JM Hew A Martijn HA Koetse CMA Bijleveld et al. (1995) ArticleTitleDoppler ultrasound and angiography of the vasculature of the liver in children after orthotopic liver transplantation: a prospective study Pediatr Radiol 25 517–24 Occurrence Handle10.1007/BF02015783 Occurrence Handle1:STN:280:BymC38vgvVI%3D Occurrence Handle8545180
T Kok MJH Slooff PMJG Peeters R Verwer CMA Bijleveld AP van den Berg et al. (1998) ArticleTitleRoutine Doppler ultrasound for the detection of clinically unsuspected vascular complications in the early postoperative phase after orthotopic liver transplantation Transpl Int 11 272–6 Occurrence Handle10.1007/s001470050140 Occurrence Handle1:STN:280:DyaK1czntVSisQ%3D%3D Occurrence Handle9704390
M Fujimoto F Moriyasu H Someda T Nada M Okuma Y Inomata et al. (1995) ArticleTitleEvaluation of portal hemodynamics with Doppler ultrasound in living related donor liver transplantation in children: implications for ligation of spontaneous portosystemic collateral pathways Transplant Proc 27 1174–6 Occurrence Handle1:STN:280:ByqC1cvktlU%3D Occurrence Handle7878837
Y Sugawara T Ikegami T Namba H Kimura K Inoue K Kubota et al. (1997) ArticleTitleIntraoperative evaluation of small-calibre arterial reconstructions Ultrasound Med Biol 23 473–6 Occurrence Handle10.1016/S0301-5629(97)80001-4 Occurrence Handle1:STN:280:ByiA3cvlsFY%3D Occurrence Handle9160915
YF Cheng TL Huang CL Chen TY Lee YS Chen PP Liu et al. (1998) ArticleTitleIntraoperative Doppler ultrasound in liver transplantation Clin Transplant 12 292–9 Occurrence Handle1:STN:280:DyaK1czltV2guw%3D%3D Occurrence Handle9686322
TL Huang YF Cheng TY Chen TYC Lee TY Lee YS Chen et al. (1998) ArticleTitlePortal hemodynamics in living-related liver transplantation: quantitative measurement by Doppler ultrasound Transplant Proc 30 3186–7 Occurrence Handle10.1016/S0041-1345(98)00987-7 Occurrence Handle1:STN:280:DyaK1M%2FlsFOrtQ%3D%3D Occurrence Handle9838408
TL Huang YF Cheng CL Chen TY Lee TY Chen YS Chen et al. (2000) ArticleTitleIntraoperative Doppler ultrasound in living-related liver transplantation Transplant Proc 32 2097–8 Occurrence Handle10.1016/S0041-1345(00)01585-2 Occurrence Handle1:STN:280:DC%2BD3MznsFaktQ%3D%3D Occurrence Handle11120084
S-S Tang T Shimizu R Kishimoto Y Kodama K Miyasaka (2001) ArticleTitleAnalysis of portal venous waveform after living-related liver transplantation with pulsed Doppler ultrasound Clin Transplant 15 380–7 Occurrence Handle10.1034/j.1399-0012.2001.150603.x Occurrence Handle1:STN:280:DC%2BD3MnptVeqsQ%3D%3D Occurrence Handle11737113
OT Reuthebuch A Kadner ML Lachat MI Turina (2003) ArticleTitleGraft occlusion after deployment of the symmetry bypass system Ann Thorac Surg 75 1626–9 Occurrence Handle10.1016/S0003-4975(02)04646-5 Occurrence Handle12735592
DP Taggart B Choudhary K Anastasiadis Y Abu-Omar L Balacumaraswami DW Pigott (2003) ArticleTitlePreliminary experience with a novel intraoperative fluorescence imaging technique to evaluate the patency of bypass grafts in total arterial revascularization Ann Thorac Surg 75 870–3 Occurrence Handle10.1016/S0003-4975(02)04669-6 Occurrence Handle12645709
D Stell D Downey P Marotta E Solano A Khakhar D Quan et al. (2004) ArticleTitleProspective evaluation of the role of quantitative Doppler ultrasound surveillance in liver transplantation Liver Transpl 10 1183–8 Occurrence Handle15350012
H Sugimoto T Kaneko Y Marui S Inoue T Seo T Hatsuno et al. (2001) ArticleTitleReversal of portal flow after acute rejection in living-donor liver transplantation J Hepatobiliary Pancreat Surg 8 573–6 Occurrence Handle10.1007/s005340100028 Occurrence Handle1:STN:280:DC%2BD383hslGhtw%3D%3D Occurrence Handle11956911
R Speich B Saesseli U Hoffman KA Neftel J Reichen (1988) ArticleTitleAnaphylactoid reactions to indocyanine-green administration Ann Intern Med 109 345–6 Occurrence Handle1:STN:280:BieB1c%2FgsFE%3D Occurrence Handle3395048
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Kubota, K., Kita, J., Shimoda, M. et al. Intraoperative assessment of reconstructed vessels in living-donor liver transplantation, using a novel fluorescence imaging technique. J Hepatobiliary Pancreat Surg 13, 100–104 (2006). https://doi.org/10.1007/s00534-005-1014-z
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DOI: https://doi.org/10.1007/s00534-005-1014-z