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  11. Intraoperative Indocyanine Green Fluorescence Imaging To Predict Early Hepatic Arterial Complications After Liver Transplantation

Intraoperative indocyanine green fluorescence imaging to predict early hepatic arterial complications after liver transplantation

Muga Terasawa1,2, Hiroshi Imamura2, Marc Antoine Allard1,3

  • 1Hôpital Paul Brousse, Centre Hépato-Biliaire, AP-HP, Villejuif, France.

Liver Transplantation : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society
|March 11, 2024

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View abstract on PubMed

Summary
This summary is machine-generated.

A new intraoperative method using indocyanine green dye can predict early hepatic artery complications after liver transplantation. This technique helps identify high-risk patients, potentially preventing graft loss.

Area of Science:

  • Transplantation Surgery
  • Hepatobiliary Surgery
  • Vascular Surgery

Background:

  • Early hepatic arterial occlusion (EHAO) is a severe complication following liver transplantation.
  • Standard Doppler ultrasound may not always detect subtle arterial abnormalities.
  • Timely intervention is crucial to prevent graft failure.

Purpose of the Study:

  • To introduce an innovative intraoperative criterion for assessing hepatic arterial flow abnormality.
  • To identify patients at risk for early hepatic arterial occlusion (thrombosis or stenosis).
  • To potentially guide decisions for re-anastomosis.

Main Methods:

  • Indocyanine green (ICG) dye was injected intraoperatively (0.01 mg/Kg) in 89 liver transplant recipients.
  • Fluorescence signal at the graft pedicle was quantified using ImageJ software.

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  • Fluorescence intensity curves were analyzed for correlations with EHAO.

    • Main Results:

    • Early hepatic arterial occlusion occurred in 7.8% of patients (3 thrombosis, 4 stenosis).
    • The ratio of peak to plateau fluorescence intensity and a jagged wave pattern at the plateau phase were significant predictors of EHAO.
    • A composite parameter (ratio > 0.275 and jagged wave) showed high sensitivity and specificity for predicting EHAO and thrombosis.

    Conclusions:

    • Indocyanine green fluorescence imaging provides a promising additional intraoperative tool for EHAO risk assessment.
    • This method can assist surgeons in identifying high-risk recipients, even with normal Doppler ultrasound findings.
    • Early detection can facilitate timely re-anastomosis and improve transplant outcomes.