Application of ICG fluorescence imaging in perfusion and functional evaluation of liver graft

doi:10.3877/cma.j.issn.2095-3232.2025.06.015

Abstract

Abstract:

Objective

To investigate the application of indocyanine green (ICG) fluorescence imaging in perfusion and functional evaluation of liver graft, and analyze its relationship with the incidence of early allograft dysfunction (EAD) after liver transplantation.

Methods

Clinical data of 17 patients undergoing orthotopic liver transplantation in Beijing Chaoyang Hospital, Capital Medical University from January 2021 to February 2022 were retrospectively analyzed. The informed consents of all patients and(or) their families were obtained and the local ethical committee approval was received. Among them, 12 patients were male and 5 female, aged from 34 to 72 years, with a median age of 51 years. In liver transplantation, ICG was injected intravenously after vascular anastomosis. The changes of fluorescence intensity on the surface of liver graft were quantitatively recorded by ICG fluorescence imaging, and the curve of changes of fluorescence intensity was drawn. Its relationship with perfusion and EAD of liver graft was evaluated.

Results

EAD occurred in 4 of 17 patients undergoing orthotopic liver transplantation. No adverse events or adverse reactions related to ICG injection were observed intraoperatively and during postoperative follow-up. Postoperative color Doppler ultrasound detected no thrombosis and normal blood flow in the liver grafts of all patients. The changes of lactic acid level before and after surgery (OR=1.420, 95%CI: 0.956-5.678, P=0.045) and the parameters of fluorescence curve parameter a (OR=8.150, 95%CI:1.022-16.498, P=0.028) were the independent predictors for postoperative EAD. The optimal cut-off value of parameter a was 0.011, and the area under the ROC area under the curve was 0.885 (95%CI: 0.723-1.000). The sensitivity and specificity of predicting the incidence of EAD at 7 d after liver transplantation were 0.75 and 0.77, respectively.

Conclusions

ICG fluorescence imaging is safe and feasible for perfusion and functional evaluation in liver transplantation. The change of fluorescence signal time is analyzed by establishing the model of fluorescence intensity curve with multiple parameters and calculating fluorescence intensity curve parameter, which has high predictive value for the incidence of postoperative EAD.

Key words: Indocyanine green, Fluorescence intensity, Liver transplantation, Graft function, Early allograft dysfunction(EAD)

Haoran Wang, Xinyuan Liu, Hua Fan. Application of ICG fluorescence imaging in perfusion and functional evaluation of liver graft[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2025, 14(06): 912-918.

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References 27

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因素	EAD(-)组	EAD(+)组	Z值	P值
男性受者(例)	9	3	-	0.824
受者年龄[岁, M(Min~Max)]	53(34~72)	48(34~67)	1.680	0.564
受者原发病(例)
肝细胞癌	3	0	-	0.290
酒精性肝硬化	3	0	-	0.290
乙肝肝硬化	3	2	-	0.301
丙肝肝硬化	1	0	-	0.568
自身免疫性肝硬化	1	0	-	0.568
胆汁性肝硬化	1	0	-	0.568
肝豆状核变性	0	1	-	0.063
药物性肝损害	0	1	-	0.063
硬化性胆管炎	1	0	-	0.568
受者BMI[kg/m², M(Min~Max)]	23.2(16.3~32.0)	21.8(18.8~25.1)	0.762	0.539
受者MELD评分[分, M(Min~Max)]	23(8~40)	31(25~35)	1.859	0.115
受者手术时间 [min, M(Min~Max)]	557(380~743)	646(425~830]	1.025	0.185
受者门静脉阻断时间[min, M(Min~Max)]	141(110~184)	178(152~196)	2.540	0.034
受者术中出血量[ml, M(Min~Max)]	750(400~1 800)	1 000(400~3 000)	1.985	0.078
受者入室乳酸[mmol/L, M(Min~Max)]	1.2(0.4~1.8)	1.4(1.1~1.7)	0.820	0.425
受者出室乳酸[mmol/L, M(Min~Max)]	1.3(0.5~3.0)	2.6(1.6~3.4)	1.250	0.390
受者手术前后乳酸变化[mmol/L, M(Min~Max)]	0.4(-0.9~1.2)	1.2(0.1~2.1)	2.645	0.016
男性供者(例)	11	3	-	0.659
供者年龄 [岁, M(Min~Max)]	51(23~68)	39(31~46)	1.894	0.077
供者BMI[kg/m², M(Min~Max)]	25.7(20.3~35.0)	25.8(22.2~29.4)	0.049	0.962
供肝CIT [min, M(Min~Max)]	397(180~480)	620(300~840)	2.192	0.078
荧光曲线参数B[M(Min~Max)]	74(71~76)	74(72~77)	0.606	0.553
荧光曲线参数a[M(Min~Max)]	0.012 4(0.010 6~0.014 1)	0.010 8(0.010 5~0.011 1)	2.809	0.013

因素	EAD(-)组	EAD(+)组	Z值	P值
男性受者(例)	9	3	-	0.824
受者年龄[岁, M(Min~Max)]	53(34~72)	48(34~67)	1.680	0.564
受者原发病(例)
肝细胞癌	3	0	-	0.290
酒精性肝硬化	3	0	-	0.290
乙肝肝硬化	3	2	-	0.301
丙肝肝硬化	1	0	-	0.568
自身免疫性肝硬化	1	0	-	0.568
胆汁性肝硬化	1	0	-	0.568
肝豆状核变性	0	1	-	0.063
药物性肝损害	0	1	-	0.063
硬化性胆管炎	1	0	-	0.568
受者BMI[kg/m², M(Min~Max)]	23.2(16.3~32.0)	21.8(18.8~25.1)	0.762	0.539
受者MELD评分[分, M(Min~Max)]	23(8~40)	31(25~35)	1.859	0.115
受者手术时间 [min, M(Min~Max)]	557(380~743)	646(425~830]	1.025	0.185
受者门静脉阻断时间[min, M(Min~Max)]	141(110~184)	178(152~196)	2.540	0.034
受者术中出血量[ml, M(Min~Max)]	750(400~1 800)	1 000(400~3 000)	1.985	0.078
受者入室乳酸[mmol/L, M(Min~Max)]	1.2(0.4~1.8)	1.4(1.1~1.7)	0.820	0.425
受者出室乳酸[mmol/L, M(Min~Max)]	1.3(0.5~3.0)	2.6(1.6~3.4)	1.250	0.390
受者手术前后乳酸变化[mmol/L, M(Min~Max)]	0.4(-0.9~1.2)	1.2(0.1~2.1)	2.645	0.016
男性供者(例)	11	3	-	0.659
供者年龄 [岁, M(Min~Max)]	51(23~68)	39(31~46)	1.894	0.077
供者BMI[kg/m², M(Min~Max)]	25.7(20.3~35.0)	25.8(22.2~29.4)	0.049	0.962
供肝CIT [min, M(Min~Max)]	397(180~480)	620(300~840)	2.192	0.078
荧光曲线参数B[M(Min~Max)]	74(71~76)	74(72~77)	0.606	0.553
荧光曲线参数a[M(Min~Max)]	0.012 4(0.010 6~0.014 1)	0.010 8(0.010 5~0.011 1)	2.809	0.013

因素	OR(95%CI)	P值
门静脉阻断时间(min)	0.890(0.793~1.002)	0.155
手术前后乳酸变化(mmol/L)	1.420(1.032~5.678)	0.042
荧光曲线参数a	8.150(1.022~16.498)	0.028

因素	OR(95%CI)	P值
门静脉阻断时间(min)	0.890(0.793~1.002)	0.155
手术前后乳酸变化(mmol/L)	1.420(1.032~5.678)	0.042
荧光曲线参数a	8.150(1.022~16.498)	0.028

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