The combination of indocyanine green clearance test and model for end-stage liver disease score predicts early graft outcome after liver transplantation

Abstract

Early allograft dysfunction (EAD) and early postoperative complications are two important clinical endpoints when evaluating clinical outcomes of liver transplantation (LT). We developed and validated two ICGR15-MELD models in 87 liver transplant recipients for predicting EAD and early postoperative complications after LT by incorporating the quantitative liver function tests (ICGR15) into the MELD score. Eighty seven consecutive patients who underwent LT were collected and divided into a training cohort (n = 61) and an internal validation cohort (n = 26). For predicting EAD after LT, the area under curve (AUC) for ICGR15-MELD score was 0.876, with a sensitivity of 92.0% and a specificity of 75.0%, which is better than MELD score or ICGR15 alone. The recipients with a ICGR15-MELD score ≥0.243 have a higher incidence of EAD than those with a ICGR15-MELD score <0.243 (P <0.001). For predicting early postoperative complications, the AUC of ICGR15-MELD score was 0.832, with a sensitivity of 90.9% and a specificity of 71.0%. Those recipients with an ICGR15-MELD score ≥0.098 have a higher incidence of early postoperative complications than those with an ICGR15-MELD score <0.098 (P < 0.001). Finally, application of the two ICGR15-MELD models in the validation cohort still gave good accuracy (AUC, 0.835 and 0.826, respectively) in predicting EAD and early postoperative complications after LT. The combination of quantitative liver function tests (ICGR15) and the preoperative MELD score is a reliable and effective predictor of EAD and early postoperative complications after LT, which is better than MELD score or ICGR15 alone.

Indocyanine green clearance tests to assess liver transplantation outcomes: a systematic review

“…Four of the six single-centre observational studies were prospective, and two were retrospective cohort studies. Only two studies tested the predictive ability of the prognostic factor in an internal validation cohort 29 , 30 . The recruitment method of participants was not always reported.…”

Predictive Value of Indocyanine Green Plasma Disappearance Rate on Liver Function and Complications After Liver Transplantation

“…In some previous studies, Olmedilla et al also found that a PCR level of <10–13%/min in the early post-transplant period was related to graft dysfunction [ 14 , 27 , 28 ]. In another study, conducted by Tian et al, 62 patients underwent PCR tests within 2 weeks following liver transplantation and the results showed a significant correlation among the levels of total bilirubin, pre-albumin, and albumin measured at different time points; therefore, the authors treated the declined value of PDR as an independent risk factor of graft dysfunction during the early post-transplant period [ 29 , 30 ]. It should be noted that PDR is affected by the volume of hepatic blood flow and the ability of the liver to eliminate ICG.…”

Comprehensive Approach to Assessment of Liver Viability During Normothermic Machine Perfusion

“…The ICG clearance test is a useful quantitative evaluation of liver function before transplantation. 97,98 Tang et al 98 found that the donor ICG retention rate at 15 m (ICGR15) before procurement was independently associated with survival at 3 months post-transplantation. That study also reported that the optimal donor ICGR15 cutoff was 11.0%/m and that it could be used as an early indicator of liver quality.…”