Skip to main content
SpringerLink
Log in

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

  • SSAT poster
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

Abstract

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Figure 1
Figure 2

Similar content being viewed by others

References

  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.

    Article  PubMed  Google Scholar 

  2. Leevy CM, Mendenhall CL, Lesko W, Howard MM. Estimation of hepatic blood flow with indocyanine green. J Clin Invest 1962;41:1169–1179.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  4. Paumgartner G. The handling of indocyanine green by the liver. Schweiz Med Wochenschr 1975;105:1–30.

    PubMed  CAS  Google Scholar 

  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.

    PubMed  CAS  Google Scholar 

  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. 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.

    Article  PubMed  CAS  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  CAS  Google 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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    PubMed  CAS  Google Scholar 

  22. Sen S, Williams R, Jalan R. Emerging indications for albumin dialysis. Am J Gastroenterol 2005;100:468–475.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    PubMed  CAS  Google Scholar 

  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.

    PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  29. Ott P, Bass L, Keiding S. The kinetics of continuously infused indocyanine green in the pig. J Pharmacokinet Biopharm 1996;24:19–44.

    Article  PubMed  CAS  Google Scholar 

  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.

    PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  33. Ibla JC, Khoury J. Methods to assess tissue permeability. Methods Mol Biol 2006;341:111–117.

    PubMed  Google Scholar 

Download references

Acknowledgments

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.

Author information

Authors and Affiliations

  1. Department of Visceral and Transplant Surgery, University Hospital Bern, CH-3010, Bern, Switzerland

    Lukas Bruegger, Peter Studer, Stefan W. Schmid, Christian Seiler, Daniel Candinas & Daniel Inderbitzin

  2. Institute of Anaesthesiology, University Hospital Bern, Bern, Switzerland

    Gunther Pestel

  3. Institute of Clinical Pharmacology, University Hospital Bern, Bern, Switzerland

    Juerg Reichen

Authors
  1. Lukas Bruegger
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Peter Studer
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Stefan W. Schmid
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Gunther Pestel
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Juerg Reichen
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Christian Seiler
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Daniel Candinas
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Daniel Inderbitzin
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Daniel Inderbitzin.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Bruegger, L., Studer, P., Schmid, S.W. et al. Indocyanine Green Plasma Disappearance Rate During the Anhepatic Phase of Orthotopic Liver Transplantation. J Gastrointest Surg 12, 67–72 (2008). https://doi.org/10.1007/s11605-007-0352-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11605-007-0352-3

Keywords

Search

Navigation