Gonzalez Esteban Horacio, Nacif Lucas Souto, Flores Cassenote Alex Jones, Pinheiro Rafael Soares, Rocha-Santos Vinicius, Bronze de Martino Rodrigo, Waisberg Daniel Reis, Arantes Rubens Macedo, Ducatti Liliana, Haddad Luciana, Galvão Flávio, Andraus Wellington, D'Albuquerque Luiz Carneiro
Liver and Gastrointestinal Transplant Division, Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo, Brazil.
Liver and Gastrointestinal Transplant Division, Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo, Brazil.
Transplant Proc. 2020 Jun;52(5):1336-1339. doi: 10.1016/j.transproceed.2020.02.025. Epub 2020 Mar 13.
Liver transplantation (LT) has evolved to improve graft and patient survival. Early graft dysfunction (EGD) and primary nonfunction are an important cause of morbi-mortality. We had formulated the scientific hypothesis that the liver function can be evaluated by the indocyanine green (IG) after LT. The aim was to evaluate the EGD by plasma disappearance rate (PDR) of IG after LT.
Prospective and observational clinical study, from July 2014 to June 2015. IG evaluation by pulse densitometry, Limon system. Degree analysis of ischemia and reperfusion injury in groups as follows: 1 (G0/G1/G2) and 2 (G3/G4). Donor risk index (DRI), Wagener and Olthoff criteria, and prognostic predictors were evaluated. All tests were performed with bidirectional α of 0.05 and a confidence interval of 95% and support by IBM SPSS 25.
A total of 40 patients, mean age 53.3 ± 14.0 years and a majority of men and hepatitis C virus. PDR were more relevant with high degrees of ischemia and reperfusion injury grades G3/G4 (P = .030). The PDR related to the donor risk index showed positive significance at DRI >1.5 (P = .066). The retention rate of IG at 15 minutes demonstrated potential in assessing graft loss or death (P = .063).
EGD can be assessed by PDR with high degrees of ischemia and reperfusion injury (G3/G4) and with marginal donors (DRI >1.5). The retention rate of IG at 15 minutes demonstrated potential in assessing graft loss or death of the patient.
肝移植（LT）已不断发展以提高移植物和患者的生存率。早期移植物功能障碍（EGD）和原发性无功能是导致发病和死亡的重要原因。我们提出了一个科学假设，即肝移植后可通过吲哚菁绿（IG）评估肝功能。目的是通过肝移植后IG的血浆消失率（PDR）评估EGD。
2014年7月至2015年6月进行的前瞻性观察性临床研究。采用Limon系统通过脉搏光密度法评估IG。对如下两组的缺血再灌注损伤程度进行分析：1组（G0/G1/G2）和2组（G3/G4）。评估供体风险指数（DRI）、瓦格纳和奥尔特霍夫标准以及预后预测因素。所有检验均采用双向α为0.05和95%的置信区间，并由IBM SPSS 25提供支持。
共纳入40例患者，平均年龄53.3±14.0岁，男性居多，且多数为丙型肝炎病毒感染者。PDR与高度缺血再灌注损伤分级G3/G4更相关（P = 0.030）。与供体风险指数相关的PDR在DRI>1.5时显示出阳性意义（P = 0.066）。IG在15分钟时的滞留率在评估移植物丢失或死亡方面具有潜力（P = 0.063）。
对于高度缺血再灌注损伤（G3/G4）和边缘供体（DRI>1.5），可通过PDR评估EGD。IG在15分钟时的滞留率在评估患者移植物丢失或死亡方面具有潜力。
