Assessment of liver perfusion and function by indocyanine green in the perioperative setting and in critically ill patients

Sakka, Samir G.

doi:10.1007/s10877-017-0073-4

Cited by 41 publications

(33 citation statements)

References 73 publications

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“…Currently, this score is used by the United Network for Organ Sharing (UNOS) and Eurotransplant for prioritizing allocation of liver transplants (12,13). The clearance of indocyanine green (ICG-15) at 15 min can be used as a defining criterion for the selection of patients as well as liver resection type (14,15). Moreover, the newly developed LiMAx® (Humedics, Berlin, Germany) test, a 13 C-labelled methacetin-based metabolic liver function capacity test, is a suitable diagnostic tool to predict the individual risk of postoperative liver failure after liver surgery (16).…”

Section: Preoperative Assessmentmentioning

confidence: 99%

Current Topics and Perspectives in Surgical Management of Hepatocellular Carcinoma

Lünse

Heidecke

Partecke

2019

Hepatocellular Carcinoma

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Hepatocellular carcinoma is among the leading causes of cancer-related mortality. Due to the numerous surgical and non-surgical therapeutic options, the treatment strategy requires an optimal selection of patients based on tumor stage and liver functional reserve. A potentially curative surgical resection or liver transplantation is only recommended for patients with early stage disease. In this chapter, we overview the current topics and perspectives in the surgical management of hepatocellular carcinoma by disease stage with a special focus on new surgical techniques and expanding range of indications outside of the accepted Barcelona Clinic Liver Cancer algorithm.

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Section: Preoperative Assessmentmentioning

confidence: 99%

Current Topics and Perspectives in Surgical Management of Hepatocellular Carcinoma

Lünse

Heidecke

Partecke

2019

Hepatocellular Carcinoma

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confidence: 93%

“…In other words, the pathways of the mind from basic knowledge to symptom and its reverse are not the same. In the present issue, the review article from Dr Sakka is an interesting opportunity to illustrate this huge difficulty [1].The present author presents the current position of the use of indocyanine green (ICG) in assessing liver perfusion and function. This molecule has a twofold property that makes it of interest in the liver exploration.…”

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confidence: 98%

The challenge of exploring organ function: knowledge is not care, but care needs knowledge!

Viale

Bendjelid

2017

J Clin Monit Comput

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The medical strategies of various diseases are not a straightforward process but are rather the result of complex development. These strategies are generally described as a backand-forth approach between the basic knowledge of disease pathophysiology and observations of symptoms. Results of clinical investigations or monitoring tools are often surrogates of collection of symptom, and therefore, this approach is renewed when an innovative tool becomes available. The respective role of each component, i.e., the basic knowledge, the new technique, and the clinical approach, varies according to the pathology or organ involved in the considered illness, but the rationale stays the same. However, this simplified pattern of medical approach does not fully describe the actual way of medical thinking. Indeed, this later is made more complex as the path of thinking from basic knowledge to symptom is not the same that the one required to discover the cause of a symptom. In other words, the pathways of the mind from basic knowledge to symptom and its reverse are not the same. In the present issue, the review article from Dr Sakka is an interesting opportunity to illustrate this huge difficulty [1].The present author presents the current position of the use of indocyanine green (ICG) in assessing liver perfusion and function. This molecule has a twofold property that makes it of interest in the liver exploration. First, the transcutaneous spectrophotometric determination of ICG allows the ICG kinetics to be measured in a non-invasive manner, and it can be performed easily at the bedside. Second, due to the particular pharmacodynamics of ICG, which is exclusively taken up by the liver and lacks entero-hepatic recirculation, its elimination rate is exclusively dependent on the liver. As all molecule cleared by the liver, its elimination depends on the liver blood flow and extraction rate, this later being very high in physiological conditions, the elimination is mainly dependent on the liver blood flow.As the factors leading to change in ICG kinetics are clearly known, it becomes reasonably easy to anticipate the effect of a variation in any of them. For example, a decrease in liver blood flow is expected to decrease ICG elimination and vice versa. If the blood flow remains stable, a change in extraction rate, which is assumed to be equivalent to liver function, leads to a change in the same direction in ICG kinetics. This deduction is a forward way of thinking, leading from physiological knowledge to the clinical effect. Conversely, the clinician faces the opposite position where he knows the result of ICG kinetics and must infer the factor or factors involved in the observed change. ICG kinetics is a warning signal arising from a systematic assessment of liver function or the result of a targeted investigation to quantify a liver injury. Regardless of the demand, the clinician faces a backward process of reasoning, which is far more challenging than the forward process is.Taking once more the example of ICG kinetics given by...

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“…The main methods to assess both liver quality and the pathological changes include ultrasound, positron emission tomography (PET), magnetic resonance imaging (MRI), computed tomography (CT), biochemical blood analysis, morphological and immunohistochemical analysis of biopsy specimens, and clearance tests using indocyanine, as well as various radioactive isotopes. [1][2][3] Ultrasound, PET, MRI, and CT are quite informative, but they only provide information about the liver tissue at the level of the *Address all correspondence to Daria Kuznetsova, E-mail: daria.s.kuznetsova@gmail.com whole organ, not allowing resolution at a cellular level. Biochemical blood analysis is among the simplest methods for studying liver function.…”

Section: Introductionmentioning

confidence: 99%

“…Clearance tests are based on an assessment of the rate of removal of various substances from biological fluids or body tissues, and can characterize the absorption and excretory function of the liver. 1 However, they do not provide information about the processes occurring in the liver tissues at the level of individual hepatocytes. Thus, these conventional techniques are insufficient to describe precisely the internal structure, heterogeneous cell populations, and the dynamics of the biological processes of the diseased liver during surgery.…”

Section: Introductionmentioning

confidence: 99%

Metabolic imaging and secondary ion mass spectrometry to define the structure and function of liver with acute and chronic pathology

et al. 2019

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Conventional techniques are insufficient precisely to describe the internal structure, the heterogeneous cell populations, and the dynamics of biological processes occurring in diseased liver during surgery. There is a need for a rapid and safe method for the successful diagnosis of liver disease in order to plan surgery and to help avoid postoperative liver failure. We analyze the progression of both acute (cholestasis) and chronic (fibrosis) liver pathology using multiphoton microscopy with fluorescence lifetime imaging and second-harmonic generation modes combined with time-of-flight secondary ion mass spectrometry chemical analysis to obtain new data about pathological changes to hepatocytes at the cellular and molecular levels. All of these techniques allow the study of cellular metabolism, lipid composition, and collagen structure without staining the biological materials or the incorporation of fluorescent or other markers, enabling the use of these methods in a clinical situation. The combination of multiphoton microscopy and mass spectrometry provides more complete information about the liver structure and function than could be assessed using either method individually. The data can be used both to obtain new criteria for the identification of hepatic pathology and to develop a rapid technique for liver quality analysis in order to plan surgery and to help avoid postoperative liver failure in clinic. © The Authors. Published by SPIE under a Creative Commons Attribution 4.0 Unported License. Distribution or reproduction of this work in whole or in part requires full attribution of the original publication, including its DOI.

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Assessment of liver perfusion and function by indocyanine green in the perioperative setting and in critically ill patients

Cited by 41 publications

References 73 publications

Current Topics and Perspectives in Surgical Management of Hepatocellular Carcinoma

Current Topics and Perspectives in Surgical Management of Hepatocellular Carcinoma

The challenge of exploring organ function: knowledge is not care, but care needs knowledge!

Metabolic imaging and secondary ion mass spectrometry to define the structure and function of liver with acute and chronic pathology

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