Advantages of using indocyanine green in liver transplantation: a narrative review

Abstract

Objective: To assess the role of indocyanine green in liver transplantation and to lay the foundation for its application in clinical practice.Background: Liver transplantation offers the best prognosis for patients with end-stage liver disease.However, this invasive procedure involves multiple well-known challenges, including complications due to graft rejection and dysfunction, surgical risks, and critical postoperative management. Intraoperative methods to assess graft function rely on conventional methods, such as blood chemistries and Doppler ultrasound.However, these methods are limited in their abilities to assess liver conditions, predict functional outcomes of the graft, and prevent surgical complications. Thus, identifying a more effective and comprehensive detection method is necessary.Methods: The information used to write this narrative review was collected from the references' opinions and conclusions.Conclusions: Indocyanine green can effectively monitor blood flow during surgery, evaluate donor graft function, and monitor the recipients functional status during and after surgery. It may also help surgeons to predict the prognosis of patients throughout the liver transplantation process, from assessing patients for liver transplantation status to postoperative management. Therefore indocyanine green should be routinely used in liver transplantation to help re-organize the transplant waiting list and improve the surgical outcomes of liver transplantation patients.

Intraoperative indocyanine green fluorescence imaging to predict early hepatic arterial complications after liver transplantation

“…administration, ICG is rapidly and extensively bound to plasma proteins and is confined to the intravascular compartment without leakage into the interstitium, making it an ideal blood contrast agent. [28,29] Because the emitted light is in the near-infrared spectrum that better penetrates living tissue compared with visible light, this technique is particularly suited to visualizing small blood vessels and tissue perfusion of an organ surface in the body cavity in a real-time manner in the operating theater. Although it was initially used as a tool of fluorescent angiography (ophthalmology or to confirm the patency of coronally artery bypass [30] ), the usual fluorescence imaging applications in hepatobiliary surgeries are the following: bile duct identification, cancer identification, and staining of anatomical areas.…”

“…Following i.v. administration, ICG is rapidly and extensively bound to plasma proteins and is confined to the intravascular compartment without leakage into the interstitium, making it an ideal blood contrast agent 28,29 . Because the emitted light is in the near-infrared spectrum that better penetrates living tissue compared with visible light, this technique is particularly suited to visualizing small blood vessels and tissue perfusion of an organ surface in the body cavity in a real-time manner in the operating theater.…”

Use of Fluorescence Imaging in Liver Transplant Surgery

“…After the transplantation, ICG can be used to continue monitoring the graft's function and blood flow during the postoperative period using ICG kinetics during the following days after transplantation; this includes the evaluation of ICG clearance just like in the preoperative phase [25]. This can help detect any issues early on and guide the management of the patient's care [1].…”

“…One of the tools available to surgeons is fluorescence imaging, which, during liver transplantation, demonstrably enhances surgical techniques by facilitating real-time visualization of key anatomical structures and improves postoperative care by enabling quantitative assessment of graft function. This last function potentially leads to earlier detection and intervention in cases of graft failure [1,2]. Fluorescence imaging technology has revolutionized the way surgeons approach liver transplants, improving patient safety and surgical outcomes.…”