Intraoperative ICG plasma disappearance rate helps to predict absence of early postoperative complications after orthotopic liver transplantation

Early postoperative complications after orthotopic liver transplantation (OLT) are a common problem in intensive care medicine. Adequate assessment of initial graft function remains difficult, however, plasma disaperance rate of indocyanine green (PDR_ICG) may have an additional diagnostic and prognostic value in this setting. We retrospectively evaluated the ability of intraoperative PDR_ICG values to predict absence of early postoperative complications in 62 subjects. PDR_ICG was measured non-invasively by pulse dye densitometry during surgery and was correlated with initial graft function. At the end of surgery, PDR_ICG was higher in patients without complications: 24.9 % min⁻¹ (n = 40) versus 21.0 % min⁻¹, (n = 22; p = 0.034). An area under the ROC curve (AUROC) for PDR_ICG was 0.70, while the AUROC for pH, lactate and PT at ICU admission were 0.53, 0.50 and 0.46, respectively. The AUROC of serum bilirubin and PT at postoperative day 5 were 0.68 and 0.49, respectively. The optimal cut-off PDR_ICG value for predicting absence of development early postoperative complications was determined to be 23.5 % min⁻¹ with 72.4 % sensitivity and 71.0 % specificity. Intraoperative point-of-care PDR_ICG measurement during OLT already predicts absence of early postoperative complications, better and earlier than clinically used laboratory parameters.