Feasibility of indocyanine green fluorescence imaging to predict biliary complications in living donor liver transplantation: A pilot study.

Abstract

Backgrounds/aims: Liver transplantation (LT) is now a critical, life-saving treatment for patients with liver cirrhosis or hepatocellular carcinoma. Despite its significant benefits, biliary complications (BCs) continue to be a major cause of postoperative morbidity. This study evaluates the fluorescence intensity (FI) of the common bile duct (CBD) utilizing near-infrared indocyanine green (ICG) imaging, and examines its association with the incidence of BCs within three months post-LT.

Methods: This investigation analyzed data from nine living donor LT (LDLT) recipients who were administered 0.05 mg/kg of ICG prior to bile duct anastomosis. Real-time perfusion of the CBD was recorded for three minutes using an ICG camera, and FI was quantified using Image J (National Institutes of Health). Key parameters assessed included F max, F_1/2 max, T_1/2 max, and the slope (F max/T max) to evaluate the fluorescence response.

Results: BCs occurred in two out of nine patients. These two patients exhibited the longest T_1/2 max values, which were linked with lower slope values, implicating a potential relationship between extended T_1/2 max, reduced slope, and the occurrence of postoperative BCs.

Conclusions: The study indicates that ICG fluorescence imaging may serve as an effective tool for assessing bile duct perfusion in LDLT patients. While the data suggest that an extended T_1/2 max and lower slope may correlate with an increased risk of BCs, further validation through larger studies is required to confirm the predictive value of ICG fluorescence imaging in this setting.