Indocyanine green kinetics to assess liver function: Ready for a clinical dynamic assessment in major liver surgery?

Abstract

Indocyanine green (ICG) kinetics (PDR/R15) used to quantitatively assess hepatic function in the perioperative period of major resective surgery and liver transplantation have been the object of an extensive, updated and critical review. New, non invasive bedside monitors (pulse dye densitometry technology) make this opportunity widely available in clinical practice. After having reviewed basic concepts of hepatic clearance, we analysed the most common indications ICG kinetic parameters have nowadays in clinical practice, focusing in particular on the diagnostic and prognostic role of PDR and R15 in the perioperative period of major liver surgery and liver transplantation. As recently pointed out, even if of extreme interest, ICG clearance parameters have still some limitations, to be considered when using these tests.

Keywords: Hepatic clearance; Indocyanine green; Intraabdominal hypertension; Liver function tests; Liver surgery; Liver transplantation; Portal hypertension.

Figures

Figure 1

Liver function assessment: Static and dynamic tests (modified from Sakka[3], 2007). AST: Aspartate aminotransferase; ALT: Alanine aminotransferase; ICG: Indocyanine green; GGT: Gamma glutamyl transferase.

Figure 2

Indocyanine green dilution curve. A: First peak; B: Second peak (re-circulation phase); C: Elimination phase (Modified from Vos et al[6], 2014). ICG: Indocyanine green; CICG: ICG blood concentration.

Figure 3

Schematic representation of indocyanine green kinetics (modified from Imamura et al[5], 2005).

Figure 4

Makuuchi decisional algorithm to select liver resective procedures in cirrhotic patients according to liver functional reserve (from Imamura et al[5], 2005). ICGR15: Indocyanine green retention ratio at 15 min.