Comparison of invasive and noninvasive measurement of plasma disappearance rate of indocyanine green in patients undergoing liver transplantation: A prospective investigator-blinded study

Abstract

Plasma disappearance rate of indocyanine green (PDRICG) has been proposed for assessment of liver function in liver transplants donors and recipients, in patients with chronic liver failure, and as a prognostic factor in critically ill patients. The assessment of PDRICG using a newly developed noninvasive digital pulse densitometry method was simultaneously compared to invasive aortic fiber-optic method in patients undergoing orthotopic liver transplantation (OLT). Fourteen consecutive liver transplant candidates (11 male, 3 female) were prospectively enrolled into the study. A 4F aortic catheter with an integrated fiber-optic device and a thermistor was inserted via a femoral artery sheath for invasive aortic (INV) PDRICG assessment in all patients. The fiber-optic device was connected to a computer system (COLD-Z021, PULSION Medical Systems, Munich, Germany). A finger-piece sensor was used for non-invasive (NINV) pulsedensitometric PDRICG assessment. For the PDRICG assessment .5 mg/kg of ICG in cooled saline (10-15 mL) was injected through a central venous catheter. The assessments of PDRICG were performed after induction of anesthesia, after clamping of the hepatic artery, after clamping of the inferior vena cava, after reperfusion of the graft, and on the first postoperative day. During the PDRICG measurements, the investigators were blinded for the results of the noninvasive monitoring. Seventy-one pairs of measurements were performed successfully. PDRICG ranged from 0%/min to 43.8 %/min (11.6%/ min ؎ 9.6 %/min, mean ؎ SD) for invasive and from I ndocyanine green (ICG) is a water-soluble anioniccompound that is injected intravenously and binds mainly albumin and ␤-lipoproteins in the plasma. ICG is then selectively taken up by hepatocytes, independent of adenosine triphosphate (ATP), and is later excreted unchanged into the bile via an ATP-dependent transport system. It is not metabolized and does not undergo enterohepatic recirculation. 1 Due to these features, ICG has been proposed for assessment of liver function in liver tranplants donors and recipients, in patients with chronic liver failure, and as a prognostic factor in critically ill patients. 2 -5 Plasma disappearance rate of ICG (PDRICG), plasma clearance rate, and retention rate are some of the parameters calculated from the decay of the dilution curve after intravenous ICG injection. PDRICG is the most commonly used ICG-derived parameter for clinical and experimental assessment of liver function with normal range of 18 -25 %/min.There are different techniques assessing the PDRICG in vivo. The gold standard relies on serial blood sampling after ICG injection at certain time intervals and consecutive spectrophotometric concentration analysis. 3,4 However, this method proves to be both expensive and time consuming. Another method implements the use of a fiber-optic aortic catheter inserted via the femoral artery sheath. 6,7 This method was found to correlate well with the serial blood-samAbbreviations: ICG, indocyanine green; ATP, adenosine tripho...

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