Abstract
BackgroundAlthough marginal donor livers expand the donor pool, an ideal method for quantitatively evaluating the quality of donor livers has not been developed. This study aimed to explore the feasibility of indocyanine green (ICG) fluorescence imaging for estimating liver function in an ischemia–reperfusion model.MethodsForty-eight rats were randomly and evenly divided into 8 groups: the control group and the experimental groups (I-VII). The portal vein blocking period was 0 min, 10 min, 20 min, 30 min, 40 min, 50 min and 60 min. After blood flow was reestablished and the hemodynamics stabilized, ICG was injected through the dorsal penile vein as a bolus, and the fluorescence signal was recorded for 30 min in real time. The fluorescence intensity (FI) curve of the liver was fitted with an asymptotic regression model. Fresh liver tissues and serum were obtained from the middle lobe of the liver on postoperative day (POD) 1 and POD 7 for histopathological evaluation and liver function tests.ResultsThe growth rate of the FI curve, parameter b3, decreased from groups I to VII. According to the two sudden changes in b3 (20 min, 50 min), the experimental groups could be classified into 3 groups (A, B and C). Hepatocytes in groups I-II showed slight edema, group III began to show obvious hepatocyte edema and vacuolar degeneration, and in groups VI-VII, severe hepatocyte degeneration, necrosis and large inflammatory cell infiltration were observed. Suzuki’s scores in the 3 groups were also significantly different (P < 0.01). At the same time, the serum liver function in the experimental groups showed a significant increase on POD 1 and a decrease on POD 7. The alanine aminotransferase (ALT), aspartate aminotransferase (AST), and total bilirubin (TB) levels of groups A, B, and C were significantly different on POD 1 (P < 0.05), and the ALT and direct bilirubin (DB) levels were significantly different on POD 7 (P < 0.05); the lactic dehydrogenase (LDH) level of the group C was significantly higher than that of the groups A and B on POD 1 and POD 7. Meanwhile, the 7-day survival rate of the rats in group C was poor compared to that of the rats in groups A and B (58.3% vs. 100% vs. 100%).ConclusionICG fluorescence imaging is effective for estimating the degree of liver damage and grading in an ischemia–reperfusion model. It probably has the potential for use in assessing the quality of the donor liver in liver transplantation.
Highlights
Marginal donor livers expand the donor pool, an ideal method for quantitatively evaluating the quality of donor livers has not been developed
indocyanine green (ICG) fluorescence imaging is effective for estimating the degree of liver damage and grading in an ischemia–reperfusion model
It probably has the potential for use in assessing the quality of the donor liver in liver transplantation
Summary
Marginal donor livers expand the donor pool, an ideal method for quantitatively evaluating the quality of donor livers has not been developed. This study aimed to explore the feasibility of indocyanine green (ICG) fluorescence imaging for estimating liver function in an ischemia–reperfusion model. Because the subjective judgment of transplant doctors is limited by experience, pathology and imaging methods are invasive and lack convenience, a unified evaluation standard for liver donors has not yet been formed. Indocyanine green (ICG) is the only fluorescent imaging substance approved by the Food and Drug Administration (FDA) for use in humans [4]. As ICG is metabolized only by the liver, fluorescence imaging with ICG is expected to be ideal for assessing donor livers
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