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Indocyanine green elimination but not bilirubin indicates improvement of graft function during MARS therapy
Author(s) -
Scheingraber Stefan,
Richter Sven,
Igna Dorian,
Girndt Matthias,
Flesch Sarah,
Kleinschmidt Stefan,
Schilling Martin K
Publication year - 2007
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/j.1399-0012.2007.00706.x
Subject(s) - indocyanine green , medicine , bilirubin , liver function , prothrombin time , area under the curve , urology , receiver operating characteristic , gastroenterology , liver function tests , nuclear medicine , surgery
Measurement of indocyanine green plasma disappearance rate (PDR ICG ) has been suggested as a meaningful liver function parameter. However, there are only very limited data concerning its value in the monitoring of graft dysfunction (GDF) and primary non‐function (PNF) especially during molecular absorbent recirculating system (MARS) therapy. This study was therefore performed to evaluate the diagnostic accuracy to detect and monitor GDF with the measurement of the PDR ICG in direct comparison with conventional markers like bilirubin and prothrombin time (PT). Of the 19 liver recipients, four patients with GDF and two patients with PNF were treated with 38 MARS cycles. Only PDR ICG did reliably indicate liver function between patients with GDF/PNF and patients with sufficient graft function who served as controls. Moreover, receiver operating characteristic analysis showed the highest areas under the curve (AUC) for PDR ICG (AUC PDRICG max : 0.840, AUC PDRICG max : 0.822), followed by bilirubin (AUC bilirubin : 0.528) and PT (AUC PT : 0.546). In contrast to the decrease of the serum bilirubin concentration due to MARS, a noticeable improvement of PDR ICG was evident only in patients with GDF. Patients with acute fulminant failure and PNF had significantly lower PDR ICG values, which did not improve even during continuous MARS treatments. Conclusively, monitoring of PDR ICG is superior to bilirubin and PT measurements to determine the graft function especially in patients with PNF and GDF undergoing MARS therapy.