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Vol. 44. Issue 10.
Pages 687-695 (December 2021)
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Vol. 44. Issue 10.
Pages 687-695 (December 2021)
Original article
Association between indocyanine green clearance test and ischemic type biliary lesions within one year after orthotopic liver transplantation
Asociación entre la prueba de clearance verde de indocianina y las lesiones biliares de tipo isquémico dentro de un año después del trasplante ortotópico de hígado
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Vittorio Cherchia, Luigi Vetrugnob,c, Victor Zaninib,c, Riccardo Pravisania,b, Marco Ventinb,
Corresponding author
marco.ventin@hotmail.it

Corresponding author.
, Dario Lorenzina, Gian Luigi Adania, Lucrezia Clocchiattia,b, Erica Boscoloa,b, Alessandro Vitd, Massimo Sponzad, Lorenzo D’Alìe, Carla Di Loretob,e, Tiziana Boveb,c, Giovanni Terrosua,b, Andrea Risalitib, Umberto Baccarania,b
a General Surgery Clinic and Liver Transplant Center, University-Hospital of Udine, Udine, Italy
b Department of Medicine, University of Udine, Udine, Italy
c Department of Anesthesia and Intensive Care, University-Hospital of Udine, Udine, Italy
d Division of Vascular and Interventional Radiology, University-Hospital of Udine,Udine, Italy
e Anatomic Pathology Institute, ASUFC University Hospital, University-Hospital of Udine, Udine, Italy
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Table 1. Patient demographic, clinical and laboratory data.
Table 2. Association with presence/absence of ITBLs.
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Abstract
Background

Ischemic type biliary lesions (ITBLs), a particular subset of non-anastomotic biliary strictures (NAS), are characterized by intra and extrahepatic strictures that occur in the absence of either hepatic artery thrombosis or stenosis. When they occur within the first year after liver transplantation their development is mostly related to ischemia–reperfusion injury (IRI). The indocyanine green plasma disappearance rate (ICG-PDR) might be able to predict the probability of IRI-induced graft damage after liver transplantation.

Objective

Our aim was to evaluate the association between ICG-PDR and the occurrence of ITBLs. Secondly, we searched for evidence of IRI in patients presenting ITBLs.

Methods

This retrospective single-center observational study assessed a cohort of 60 liver transplant patients. Each patient underwent ICG-PDR on the 1st postoperative day. ITBLs were identified by means of either cholangiography or magnetic resonance imaging evidence of a deformity and narrowing of the biliary tree in the absence of hepatic artery thrombosis/stenosis.

Results

ITBLs were discovered in 10 patients out of 60 liver recipients (16.67%) within one year after transplantation. A low ICG-PDR value was found to be a significant predictive factor for ITBL development, with an OR of 0.87 and a 95% CI of 0.77–0.97. Liver biopsies were performed in 56 patients presenting unexplained abnormal liver function test results. A statistically significant association was found between the development of ITBLs and anatomopathological evidence of IRI.

Limitations

Retrospective, single-center study.

Conclusions

The findings from this study show a relationship between low ICG-PDR values on first post-operative-day and the occurrence of ITBLs within 1 year after transplantation.

Keywords:
Liver transplantation
Indocyanine green
Ischemia–reperfusion injury
Biliary complications
ITBL
NAS
IRI
Resumen
Antecedentes

Las lesiones biliares de tipo isquémico (ITBL) representan un subconjunto de estenosis biliares no anastomóticas, caracterizadas por estenosis intra y extrahepáticas, que ocurren en ausencia de trombosis o estenosis de la arteria hepática. Cuando ocurren dentro del primer año después del trasplante de hígado, están relacionadas principalmente con la lesión por isquemia-reperfusión (IRI). La tasa de desaparición del plasma con verde de indocianina (ICG-PDR) podría estimar el daño del injerto inducido por IRI después de un trasplante.

Objetivo

Nuestro objetivo es evaluar la asociación entre ICG-PDR y la aparición de ITBL. También investigamos la evidencia de IRI entre los pacientes que presentaron ITBL.

Métodos

Estudio observacional, retrospectivo, unicéntrico, realizado en una cohorte de 60 receptores trasplantados con determinacion del ICG-PDR el primer día posoperatorio. Las ITBL se definieron mediante colangiografía o evidencia por resonancia magnética de deformidad del árbol biliar en ausencia de trombosis/estenosis de la arteria hepática.

Resultados

De 60 receptores, se descubrieron ITBL en 10 pacientes (16,67%) en el primer año. El valor bajo de ICG-PDR es un factor predictivo significativo para ITBL, con OR=0,87 y un IC (95%)=0,77-0,97. Se analizaron 56 biopsias hepáticas para la presencia de IRI, si los receptores presentaban una prueba de función hepática anormal inexplicable, encontrando asociación significativa entre ITBL y evidencia anatomopatológica de IRI.

Limitaciones

Estudio retrospectivo, unicéntrico.

Conclusiones

Este estudio encontró una relación entre los valores bajos de ICG-PDR en el primer día posoperatorio y la aparición de ITBL dentro de un año posterior al trasplante.

Palabras clave:
Trasplante de hígado
Verde de indocianina
Lesión por isquemia-reperfusión
Lesiones biliares de tipo isquémico
ITBL
NAS
IRI

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