Indocyanine green clearance monitoring during liver transplant for fulminant hepatic failure: preliminary results

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Introduction

The COLD System (Pulsion Medical System, Munich, Germany) allows measurements of cardiac index (CI), intrathoracic blood volume (ITBV), extravascular lung water (EVLW) and liver function through the plasma disappearance rate of indocyanine green dye (ICG) (PDRdy n.v.=20–30% min).

Methods

Six patients (6F), with a mean age of 42.2 ± 11.7 years and with a mean BSA of 1.7 ± 0.1 m², affected by fulminant hepatic failure (FHF), undergoing orthotopic liver transplantation (OLT) were studied with the COLD System to evaluate PDRdy as a marker of native and transplanted liver function and volumetric data. After anesthesia induction, a pulmonary artery catheter (Intellicath CCO; Baxter, Irvine, CA, USA) was placed via the right subclavian vein and a 3Fr thermistor-tipped fiberoptic catheter for thermal dye dilution was inserted into the descending aorta via a 4Fr introducer sheath in the femoral artery and connected to the COLD-Z021. All data were collected during the following steps: after anesthesia induction (A), during anhepatic phase (B), after graft reperfusion (C), at the end of surgery (D) and 6 h after the end of surgery (E).

Results

Results are reported in the table. Four patients had a rapid weaning, were extubated, discharged from ICU and are still enjoying good health. Two patients, despite a good liver function recovery, died with MOF.

Conclusion

The evaluation of cardiac preload is a useful tool to guide fluid replacement and vasoactive drug administration during anesthesia for a major surgical procedure such as OLT. In selected cases with FHF, PDRdy monitoring allows one to obtain an accurate bedside evaluation of graft function recovery.

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