A new study on identifying which patients were likely to have poor outcomes following a living-donor liver transplant (LDLT) found that measuring how a certain non-toxic dye was eliminated by the liver shortly after surgery was an accurate indicator of liver function, and therefore a reliable indicator of the outcome of the procedure.
The study used a simple non-invasive device to measure the dye, making it particularly useful in treating transplant patients.
The results of this study appear in the April 2006 issue of Liver Transplantation, the official journal of the American Association for the Study of Liver Diseases (AASLD) and the International Liver Transplantation Society (ILTS). The journal is published on behalf of the societies by John Wiley & Sons, Inc. and is available online via Wiley InterScience.
Monitoring liver function following LDLT is crucial and identifying poor function as early as possible would be a step in the right direction toward achieving better outcomes. Since tests traditionally used to measure liver function are not always conclusive, researchers led by Tomohide Hori of Mie University in Tsu City, Japan analyzed how indocyanine green (ICG), a non-toxic dye, was processed by the liver, assessed a non-invasive method of measuring its levels, and determined whether such a test would be a reliable indicator of outcome.
The study involved 30 adult recipients who underwent LDLT between June 2003 and February 2005 at Mie University Hospital. The patients were divided into two groups based on liver function and outcome following the transplant (as measured by traditional methods such as bilirubin concentration). Group I consisted of 24 recipients who had good clinical outcomes while group II consisted of 6 recipients who needed intensive clinical management and had poor clinical outcomes. ICG was injected into the patients and its disappearance was monitored by a non-invasive photometric device. This was done for the first 14 days following transplant (including every 12 hours in the first 72 hours) and again at 21 and 28 days following surgery.
The results showed that immediately following transplant, elimination of ICG improved for all patients in the study when compared to pre-operative tests, but within 24 hours ICG elimination was significantly better in Group I than in Group II. The test correlated well with more traditional methods of measuring liver function, specifically liver biopsies that were performed in 17 of the patients and liver scintigraphy (an imaging technique using a radioactive substance that is swallowed) performed on 18 patients. The ICG test however, had certain benefits. "This novel noninvasive method has advantages in its simplicity, its real-time presentation of results without consuming a lot of time, and its cost-effectiveness," the researchers note. They conclude that being able to predict poor outcomes based on ICG elimination immediately following liver transplants should have a large impact on further improving LDLT outcomes, since appropriate clinical management can then be instituted if necessary.