INDOCYANINE GREEN ELIMINATION TEST IN ORTHOTOPIC LIVER RECIPIENTS

Objective. To determine its predictive capability on graft quality and resultant clinical outcome, the indocyanine green (ICG) elimination t est was performed by a spectrophotometric method and a noninvasive fin ger-piece method with 50 orthotopic liver transplantations. Background . Early detection of poor-functioning hepatic grafts is one of the mos t important issues in liver transplantation, but no reliable methods e xist. Methods. The ICG test was performed after 50 orthotopic liver tr ansplantations on postoperative days 1, 3, and 7. Indocyanine green el imination constants (I((ICG)) were measured by both a standard spectro photometric analysis (K-ICG-B) and by a finger-piece method (K-ICG-F) The patients were followed for a minimum of 3 months after transplanta tion. Results of ICG tests were correlated with various clinical deter minations. Results. Twelve of the 50 grafts were lost within three mon ths, of which 7 were related to graft failure. Multivariate analysis u sing the Cox proportional hazard model revealed that K-ICG on postoper ative day 1 was a better predictor of liver-related graft outcome than any of the conventional liver function tests. Furthermore, K-ICG valu es showed significant correlation with the severity of preservation in jury, longer intensive care unit (ICU) and hospital stay, prolonged li ver dysfunction, and septic complications. Correlation of K-ICG values by the spectrophotometric method with those by the finger-piece metho d was highly satisfactory in the grafts that had K-ICG-B <0.15 min(-1) (y = 0.868x -0.011, r = .955). Conclusion. The ICG elimination test, conducted spectrophotometrically or optically on the day after liver t ransplantation, is a reliable indicator of graft quality and subsequen t graft outcome early after liver transplantation.