Escorsell À, Mas A, Fernández J, García-Valdecasas J C
ICU-IMDM, Liver Unit, Hospital Clinic, Barcelona, Catalunya, Spain.
Transplant Proc. 2012 Jul-Aug;44(6):1539-41. doi: 10.1016/j.transproceed.2012.05.023.
To assess the prognostic value of noninvasive indocyanine green (ICG) clearance (ICG-pulse-densitometric method [PDR]) for the outcome of liver grafts after transplantation.
ICG-PDR, hepatic artery resistance index, cardiac output, transaminases, prothrombin time, bilirubin, albumin, hematocrit at 48 to 72 hours after transplantation were analyzed with reference to outcome among 59 liver graft recipients.
Two grafts were lost at 10 and 88 days during the initial hospitalization. These two patients only differed from the other recipients in the need for packing (1/2 versus 3/57) and degree of hypoproteinemia (46 ± 0 versus 51 ± 7.8 g/L), whereas they had similar ICG-PDR values (16.7%/min and 21.8%/min versus 17.3%/min ± 7.2%/min). Seven patients showed an ICG-PDR ≤ 8.8%/min, a previously identified cutoff for early postoperative complications. These patients versus the other 52 significantly differed in prothrombin index (47.9% ± 15.9% versus 64.3% ± 11.7%, P = .001) and bilirubin (8.3 ± 3.2 versus 3.3 ± 2.9 mg/dL, P = .0001). Early postoperative complications--primary graft nonfunction, hepatic artery thrombosis, or septic shock--responsible for an ICG-PDR ≤ 8.8%/min were observed in 2/7 patients. Interestingly, six cases developed an early (range: 3-15 days) rejection episode. In all the cases rejection suspected by analytical abnormalities was confirmed by liver biopsy. Among the overall series of patients, ICG-PDR significantly correlated with serum albumin (r = 0.345; P = .007), bilirubin (r = -0.514; P = .0001), and hematocrit (r = 0.462; P = .0001) but not with transaminases, prothrombin index, cardiac output, or hepatic artery resistance index. Actuarial 72-month probability of graft survival was 75%. Overall, 14 grafts were lost over a median follow-up of 78 months (range 1-99 m). There were no significant differences among early ICG-PDR values among grafts lost vs retained upon follow-up.
ICG-PDR measured once early after liver transplantation did not offer relevant information to predict individual patient outcomes in the immediate postoperative phase. This lack of prognostic value may have been due to the multiple confounding factors involved in ICG metabolism after liver transplantation.
评估非侵入性吲哚菁绿（ICG）清除率（ICG脉冲密度测定法[PDR]）对肝移植术后肝移植物预后的价值。
对59例肝移植受者移植后48至72小时的ICG-PDR、肝动脉阻力指数、心输出量、转氨酶、凝血酶原时间、胆红素、白蛋白、血细胞比容进行分析，并参考其预后情况。
在初次住院期间，有2例移植物分别在术后10天和88天丢失。这2例患者与其他受者的唯一不同在于是否需要填塞（1/2比3/57）和低蛋白血症程度（46±0比51±7.8 g/L），而他们的ICG-PDR值相似（16.7%/分钟和21.8%/分钟比17.3%/分钟±7.2%/分钟）。7例患者的ICG-PDR≤8.8%/分钟，这是先前确定的术后早期并发症的临界值。这些患者与其他52例患者在凝血酶原指数（47.9%±15.9%比64.3%±11.7%，P = 0.001）和胆红素（8.3±3.2比3.3±2.9 mg/dL，P = 0.0001）方面有显著差异。在2/7的患者中观察到导致ICG-PDR≤8.8%/分钟的术后早期并发症——原发性移植物无功能、肝动脉血栓形成或感染性休克。有趣的是，有6例患者发生了早期（3 - 15天）排斥反应。所有通过分析异常怀疑的排斥反应均经肝活检证实。在整个患者系列中，ICG-PDR与血清白蛋白（r = 0.345；P = 0.007）、胆红素（r = -0.514；P = 0.0001）和血细胞比容（r = 0.462；P = 0.0001）显著相关，但与转氨酶、凝血酶原指数、心输出量或肝动脉阻力指数无关。移植肝存活的72个月精算概率为75%。总体而言，在中位随访78个月（范围1 - 99个月）期间，有14例移植物丢失。随访时丢失与保留的移植物早期ICG-PDR值之间无显著差异。
肝移植术后早期单次测量的ICG-PDR并不能为预测术后即刻个体患者的预后提供相关信息。这种缺乏预后价值可能是由于肝移植后ICG代谢涉及多种混杂因素。
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