Measurement Of Indocyanine Green Clearance Research Articles

Value of Preoperative Indocyanine Green Clearance Test for Predicting Post-Hepatectomy Liver Failure in Noncirrhotic Patients.

BackgroundLiver failure is the most feared complication following hepatectomy. Post-hepatectomy liver failure (PHLF) is closely related to the remnant liver volume, and functional reserve. There are several methods for predicting PHLF prior to liver resection. The indocyanine green (ICG) clearance test was popularized in patients with hepatocellular cancer (HCC). We aim to demonstrate the value of preoperative ICG clearance measurement via pulse spectrophotometer (LIMON®) in prediction of PHLF in noncirrhotic patients prior to liver resection.Material/MethodsFifty-three noncirrhotic patients who underwent liver resection due to different pathologies were included. Retrospectively collected clinical data, including the preoperative ICG clearance measurements and remnant liver volumes of the patients, were statistically evaluated according to the PHLF criteria of the International Study Group of Liver Surgery.ResultsFour (7.5%) patients with PHLF were observed. There was no significant difference between PHLF and non-PHLF groups regarding ICG clearance measurements with cut-off values of 5% and 9.5%.ConclusionsThe ICG clearance test does not satisfy our expectations in noncirrhotic patients in predicting PHLF. We believe that the ICG clearance test should be reserved for patients with cirrhosis and/or HCC. This test could be an option for noncirrhotic patients with chronic active hepatitis, advanced-grade fatty livers, or for patients who received long-term preoperative chemotherapy, and also for patients who underwent single or multiple sessions of TACE or TARE prior to liver resection. If the routine selection criteria have been fulfilled, there is no further need to perform the ICG clearance test for living liver donors.

Early Measurement of Indocyanine Green Clearance Accurately Predicts Short-Term Outcomes After Liver Transplantation.

There are no accurate tools to predict short-term mortality or the need for early retransplantation after liver transplantation (LT). A noninvasive measurement of indocyanine green clearance, the plasma disappearance rate (PDR), has been associated with initial graft function. We evaluated the ability of PDR to predict early mortality or retransplantation after LT. In this observational prospective study, 332 LT were analyzed. Donor, recipient, and intraoperative data were investigated. The ensuing score was prospectively evaluated in a validation cohort of 77 patients. Thirty-three patients reached the main endpoint. By multivariate analysis, the only independent predictors of the endpoint were PDR (odds ratio [OR], 0.85; 95% confidence interval, 0.79-0.92) and international normalized ratio (OR, 1.45; 95% confidence interval, 1.17-1.82). A risk score weighted by the OR was built using cutoff values of 2.2 or greater for international normalized ratio (1 point) and less than 10%/min for PDR (2 points). Four categories (0 to 3) were possible. The risk of early death or retransplantation was associated with the score (0, 4.4%; 1, 6.5%; 2, 12%; and 3, 50%; χ for trend, P < 0.001). The score was also associated with duration of mechanical ventilation and intensive care unit stay. The score had a good diagnostic performance in the validation cohort (sensitivity, 60%; specificity, 95.5%; positive predictive value, 66.7%; negative predictive value, 94.1%). A simple score obtained within the first day after LT predicts short-term survival and need for retransplantation and may prove useful when selecting diagnostic and therapeutic strategies.

PTH-120 Albi score predicts survival independently of hepatic venous pressure gradient (HVPG) and indocyanine green (ICG) clearance in HCC patients undergoing resection

Introduction A new evidence based model, the Albumin-Bilirubin (ALBI) grade, 1 has been recently proposed for assessing liver function in patients with hepatocellular carcinoma (HCC). We aimed to evaluate the impact of ALBI in predicting decompensation and survival after liver resection (LR) for HCC. Method Consecutive patients undergoing resection for HCC between 2011–2014 at the Royal Free Hospital were evaluated. Demographic, clinical data and histopathological features of resected tumour were collected. Patients underwent HVPG and ICG clearance measurement to evaluate potential resectability. ALBI score was calculated pre and post-operatively. Patients were divided into 3 categories (ALBI 1,2,3) according to published ALBI score cut-offs. Cox regression was used to identify predictors of decompensation and survival post LR. Results 48 patients were included with a median post LR follow up 17 months (1–54): male 42(87.5%), mean age 63 years (28–83). Median HVPG 6 mmHg (2–15), median ICG PDR 18.2 (6.1–29.4), median ICG R15 6.5 (1.2–19.2). All patients had a Child Pugh score A5. 46 (96%) had a pre-LR ALBI grade 1 and 2 (4%) had an ALBI grade 2. Clinically significant portal hypertension (HVPG ≥10 mmHg) was found in 11 (23%) patients. Eight (19%) patients had an ICG PDR 15. Thirty (62.5%) patients underwent an anatomical resection, while 18 (37.5%) had a wedge resection. Post-LR decompensation was observed in 5(10%) patients: ascites n = 4, encephalopathy n = 1 at a median of 10 days post-LR. 12(25%) patients had HCC recurrence after a mean time of 11 months (5–28). 7(15%) died after a mean follow up of 15 months (1–40), 3 of them due to tumour recurrence. Patients with 1 HCC Cox regression analysis of pre LR variables (HVPG, ICG, CPS, ALBI, HCC size) showed that the only factor associated with survival was pre-LR ALBI score (p = 0.019). Conclusion ALBI, an evidence based prognostic score specific to HCC, provides significant information regarding LR outcome in patients with HCC, independently of HVPG, ICG clearance and Child Pugh Score. Disclosure of interest None Declared. Reference Johnson PJ, et al . Assessment of liver function in patients with hepatocellular carcinoma: a new evidence-based approach-the ALBI grade. J Clin Oncol . 2015;33(6):550–8

Indocyanine green clearance as a predictor of outcome in liver transplant patients

Invasive measurement of indocyanine green clearance (ICG) has been shown to predict the outcome after liver transplantation in a small series of patients. A non-invasive technique using ICG plasma disappearance rate (PDR) has recently been shown to correlate well with invasive techniques. We report our experience of ICG PDR in a large cohort of liver transplant patients.

An Instrument Using an Optical Sensor for Measuring Dye Disappearance in Blood and Its Clinical Evaluation for Hepatic Diseases

An instrument to measure hepatic function was developed as a medical application of optoelectronic technology. The study of Indocyanine green (ICG) clearance in blood is clinically used for the estimation of hepatic function. Multiple blood samplings, however, subject the patients to mental and physical stress. Furthermore, although it is necessary with this method to correctly measure the blood sampling time after ICG injection, it is difficult to accurately measure this time in an actual test. Thus, a measuring method without blood sampling has been desired. Although some preliminary studies employing a non-invasive method were undertaken, there were still problems for clinical usage. Therefore, in this paper, a description of an instrument for the non-invasive measurement of ICG clearance using an optical sensor attached to the fingertip is presented, and a calibration method before ICG injection is proposed to solve the problem of changing blood volume. Next, the results of the clinical evaluation of 470 cases are presented. Using this newly developed instrument, the values of ICG tests correlated well with the values calculated from the conventional blood sampling method.

Effect of propranolol on metabolic activity of the liver in patients with alcoholic cirrhosis

Many studies have been performed to investigate the haemodynamic effects of propranolol. However, little is known of its actions on the metabolic activity of the liver. This study aimed to investigate the influence of propranolol on hepatic function as assessed by the galactose elimination capacity (GEC) and the intrinsic clearance of indocyanine green (ICG). 15 patients with biopsy-proven alcoholic cirrhosis and portal hypertension were studied. 10 had GEC and ICG clearance measured before and after the i.v. injection of 15 mg of propranolol (group P) and 5 had ICG clearance measurement before and after normal saline injection (group C). Propranolol significantly reduced heart rate (P less than 0.005) and the porto-hepatic pressure gradient (P less than 0.01). Hepatic blood flow was not changed. GEC was not altered by propranolol. Propranolol decreased the intrinsic hepatic clearance of ICG as determined by the 'sinusoidal' model by 12% (P less than 0.01). This suggests that propranolol may have an inhibitory action on the hepatic elimination of ICG that is independent of any effect on total liver blood flow or drug metabolism, since intrinsic clearance is not influenced by changes in blood flow and ICG is thought not to be metabolized.