Premium
Evaluation of the splanchnic circulation with indocyanine green pharmacokinetics in liver transplant patients
Author(s) -
Niemann Claus U.,
Yost C. Spencer,
Mandell Susan,
Henthorn Thomas K.
Publication year - 2002
Publication title -
liver transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.814
H-Index - 150
eISSN - 1527-6473
pISSN - 1527-6465
DOI - 10.1053/jlts.2002.33218
Subject(s) - indocyanine green , medicine , splanchnic , splanchnic circulation , hemodynamics , liver transplantation , intravascular volume status , transplantation , peripheral , hyperdynamic circulation , anesthesia , cardiology , surgery , vascular resistance
Although indocyanine green (ICG) can be used to estimate cardiac output (CO) and blood volume independently, a recirculatory multicompartmental ICG model enables description of these and additional intravascular factors. This model was used to describe the effect of end‐stage liver disease (ESLD) on systemic and splanchnic hemodynamics in patients undergoing orthotopic liver transplantation. ICG disposition was determined during the dissection phase in six patients with ESLD undergoing orthotopic liver transplantation and six healthy adult living liver donors. After injecting ICG, plasma concentrations were obtained for approximately 10 to 12 minutes by noninvasive pulse dye densitometry. The recirculatory model characterizes three distinct intravascular circuits: lumped parallel fast (presumably nonsplanchnic circulation) and slow peripheral (splanchnic) circuits and a central circuit (central blood volume). Mean transit time (MTT) in the fast peripheral circuit was not different in patients with ESLD and controls. However, ESLD resulted in a significant decrease in MTT in the central (0.11 ± 0.028 [SD] v 0.24 ± 0.094 minutes in controls; P < .001) and slow peripheral circuit (0.67 ± 0.41 v 1.37 ± 0.37 minutes in controls; P < .001) because of increased flows to the central and slow peripheral circuits. These findings are consistent with the described hyperdynamic systemic and splanchnic circulations in patients with ESLD. In conclusion, the ICG model is able to derive estimates of not only blood volume and CO, but also splanchnic hemodynamics under different physiological conditions. This model can be a useful tool to evaluate the effect of pharmacological manipulation of splanchnic hemodynamics.