Evaluation of Plasma Disappearance Rate Indocyanine Green Clearance as a Predictor of Liver Graft Rejection in Donor Brain Death

Asencio, José Manuel; Cortese, Sergio; Baena, José Ángel López; Olmedilla, Luis; Peña, J M; Salcedo, M.; Matilla, Ana; Martín, Laura Serrano; Martínez, Cecilia; Orue-Echebarria, Maitane I.; Rojas, Pilar

doi:10.1016/j.transproceed.2020.01.084

Cited by 7 publications

(5 citation statements)

References 9 publications

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“…In 2020, our group at "HGUGM" published results of a pilot study of 29 DBDs [11], showing a good correlation between donor's ICG-PDR and decision of the surgeon (blinded to PDR results) to accept or discard the graft. Thereafter, we recruited more donors and started a multicentric study to validate our results.…”

Section: Discussionmentioning

confidence: 99%

“…Although the ICG clearance test performed on DBDs before the procurement operation has been correlated with malfunction in the recipient [8,9] and one-week graft survival [10], it has not been validated as a tool to discard a graft before procurement. A prospective pilot study on 29 DBDs published in 2020 by our group [11] showed that an ICG-plasma disappearance rate (ICG-PDR) below 15%/min was associated with graft rejection by the surgeon who was in charge of the retrieval. The present work aimed to internally validate our previous finding in a larger cohort of donors and set the best cut-off for ICG-PDR to avoid discarding any potential valid graft.…”

Section: Introductionmentioning

confidence: 99%

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Internal and external validation of indocyanine green plasma disappearance rate to discard liver grafts before procurement

Cortese,

Plua,

Perez-Alonso

et al. 2024

Ann Hepatobiliary Pancreat Surg

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Internal and external validation of indocyanine green plasma disappearance rate to discard liver grafts before procurement

Cortese,

Plua,

Perez-Alonso

et al. 2024

Ann Hepatobiliary Pancreat Surg

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“…Despite widespread use in the evaluation of cirrhotic patients prior to hepatectomy and occasionally in the assessment of potential liver donors 19–21 and liver transplant recipients, 22 the use of ICG until now in the setting of ex situ machine perfusion has been limited 8 . In animal studies involving rats and pigs, ICG clearance has been used to assess the performance of hypothermic machine perfusion, cold static storage, and different perfusate options 23–25 .…”

Section: Discussionmentioning

confidence: 99%

Indocyanine green: A novel marker for assessment of graft quality during ex situ normothermic machine perfusion of human livers

Lau,

Ly,

Ewenson

et al. 2023

Artificial Organs

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BackgroundEx situ machine perfusion facilitates the assessment of livers prior to transplantation. However, currently available markers of liver function poorly predict long‐term graft function. Indocyanine green (ICG) is a liver‐specific dye which, although common in vivo, has never been comprehensively evaluated for the assessment of graft quality during ex situ machine perfusion. This study aimed to assess the utility of ICG in the ex situ setting.MethodsUsing a customized long‐term perfusion system, human livers that were not suitable for transplantation were perfused using a red cell‐based perfusate. ICG was delivered into the perfusate on days 0, 1, and 4 to assess ICG clearance (spectrophotometric absorbance at 805 nm) and ICG fluorescence (near‐infrared camera).ResultsSixteen partial livers were perfused for a median duration of 172 h (7.2 days). On day 0, the median ICG perfusate disappearance rate (PDR) was 7.5%/min and the median ICG retention at 15 min was 9.9%. Grafts that survived ≥7 days had a significantly higher median ICG PDR on day 0 (14.5%/min vs. 6.5%/min, p = 0.005) but not on days 1 or 4. ICG perfusion demonstrated that long‐surviving grafts had a significantly lower median red‐value (89.8 vs. 118.6, p = 0.011) and a significantly lower median blue‐value (12.9 vs. 22.6, p = 0.045) than short‐surviving grafts.ConclusionICG is a novel marker for the assessment of liver function during ex situ normothermic machine perfusion. ICG PDR and quantitative ICG perfusion can distinguish between long‐ and short‐surviving grafts and demonstrate the utility of ICG in the assessment of graft quality prior to transplant.

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“…The reported dose of ICG administered varies greatly, with a range between 0.25 and 5 mg/kg. 26,27 In a prospective study of 29 donor operations, where ICG PDR was calculated and then livers procured by blinded surgeons, a donor ICG PDR of <15% was always associated with liver discard. 27 This could prevent unnecessary surgery in marginal donors where the graft will ultimately be discarded and adds some objectivity to a surgeon's macroscopic assessment of a donor liver.…”

Section: Icg Clearance For Assessment Of Deceased Donorsmentioning

confidence: 99%

Current and Potential Applications for Indocyanine Green in Liver Transplantation

Lau

Liu

et al. 2021

Transplantation

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Indocyanine green (ICG) is a fluorescent dye taken up and almost exclusively cleared by the liver. Measurement of its clearance and visualization of its fluorescence make it suitable for a number of potential applications in liver transplantation including assessment of liver function and real-time assessment of arterial, venous, and biliary structures. ICG clearance can be used to assess donor graft quality before procurement and graft metabolic function before transplant using normothermic ex vivo machine perfusion. ICG clearance in the post–liver transplantation period is able to predict recipient outcomes with correlations to early allograft dysfunction and postoperative complications. After absorbing light in the near-infrared spectrum, ICG also emits fluorescence at 835 nm. This allows the assessment of vascular patency after reconstruction and patterns of liver perfusion in real time. ICG perfusion patterns after revascularization are also associated with posttransplant graft function and survival. ICG fluorescence cholangiography is routine in a number of centers and acts as an aid to identifying the optimal point of bile duct division during living donor liver transplantation to optimize safety for both donor and recipient. In summary, ICG is a versatile tool and has a number of useful applications in the liver transplantation journey including assessment of liver function, perfusion assessment, and cholangiography. Further research and clinical trials are required to validate and standardize its routine use in liver transplantation.

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Evaluation of Plasma Disappearance Rate Indocyanine Green Clearance as a Predictor of Liver Graft Rejection in Donor Brain Death

Cited by 7 publications

References 9 publications

Internal and external validation of indocyanine green plasma disappearance rate to discard liver grafts before procurement

Internal and external validation of indocyanine green plasma disappearance rate to discard liver grafts before procurement

Indocyanine green: A novel marker for assessment of graft quality during ex situ normothermic machine perfusion of human livers

Current and Potential Applications for Indocyanine Green in Liver Transplantation

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