Correlation Between Portal Pressure and Indocyanine Green Retention Rate is Unaffected by the Cause of Cirrhosis: A Prospective Study

Kosuke Kobayashi, Emilie Uldry, Takashi Kokudo, Alessandra Cristaudi, Yoshikuni Kawaguchi, Chikara Shirata, Takamune Yamaguchi, Olivier Dormond, Rafael Duran, Kiyoshi Hasegawa, Nicolas Demartines, Nermin Halkic, Kosuke Kobayashi, Emilie Uldry, Takashi Kokudo, Alessandra Cristaudi, Yoshikuni Kawaguchi, Chikara Shirata, Takamune Yamaguchi, Olivier Dormond, Rafael Duran, Kiyoshi Hasegawa, Nicolas Demartines, Nermin Halkic

Abstract

Background: Accurate estimation of the hepatic functional reserve before liver resection is important to avoid post-hepatectomy liver failure (PHLF). The aim of the present study was to evaluate the association of indocyanine green retention test with portal pressure by the cause of cirrhosis (non-viral vs. viral) and assessed postoperative outcomes including incidence of PHLF in patients with viral and non-viral cirrhosis.

Methods: The cohort includes 50 consecutive patients with liver cirrhosis scheduled for liver resection for primary liver tumors at the Lausanne University Hospital between 2009 and 2018.

Results: There were 31 patients with non-viral liver cirrhosis (Non-virus group) and 19 with viral liver cirrhosis (virus group). The indocyanine green retention rate at 15 min (ICG-R15) (p = 0.276), Hepatic Venous Portal Gradient (HVPG; p = 0.301), and postoperative outcomes did not differ between the non-virus group and viral group. ICG-R15 and HVPG showed a significant linear correlation in all patients (Spearman's rank correlation coefficient, ρ = 0.599, p < 0.001), the non-virus group (ρ = 0.555, p = 0.026), and the virus group (ρ = 0.534, p = 0.007). A receiver operating characteristic curve analysis showed that ICG-R15 was a predictor for presence of portal hypertension (PH; HVPG ≥ 12 mmHg) (area under the curve [AUC] = 0.780). The cut-off value of ICG-R15 for predicting the presence of PH was 16.0% with 72.3% of sensitivity and 79.0% of specificity.

Conclusions: The ICG-R15 level was associated with portal pressure in both patients with non-virus cirrhosis and patients with virus cirrhosis and predicts the incidence of PH with relatively good discriminatory ability. CLINICAL TRIAL NUMBER: https://clinicalTrials.gov(ID:NCT00827723) LOCAL ETHICS COMMITTEE NUMBER: CER-VD 251.08.

Figures

Fig. 1
Fig. 1
Patient selection
Fig. 2
Fig. 2
Correlation between the indocyanine green retention rate at 15 min (ICG-R15) and Hepatic Venous Portal Gradient (HVPG) A linear correlation was observed between ICG-R15 and HVPG. Spearman’s rank correlation coefficient of ICG-R15 and HVBG showed a significant linear correlation (a) in all patients (ρ = 0.599, p < 0.001), b the non-virus group (ρ = 0.555, p = 0.026), (c) and the virus group (ρ = 0.534, p = 0.007)
Fig. 3
Fig. 3
Portal pressure between non-virus group and virus group in all patients (a), patients with the indocyanine green retention rate < 16.0% (b), and in patients with the indocyanine green retention rate ≥ 16% (c)
Fig. 4
Fig. 4
Liver failure rate stratified by the three-level complexity classification in patients undergoing resection of grade I/II procedures (a) and patients undergoing resection of grade III procedures (b)

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