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Abstract

Indocyanine green (ICG) is a water-soluble anionic compound that binds to plasma proteins after intravenous administration. It is selectively taken up at the first pass by hepatocytes and excreted unchanged into the bile. With the development of ICG elimination measurement by spectrophotometry, the ICG retention test has become a safe, rapid, reproducible, inexpensive and noninvasive tool for the assessment of liver function. Clinical evidence suggests that the ICG retention test can enable the establishment of tailored management strategies by providing prognostic information. In particular, this method has been evaluated as a prognostic marker in patients with advanced cirrhosis or awaiting liver transplantation. In addition, it is used as a marker of portal hypertension in cirrhotic patients, as a prognostic factor in intensive care units and for the assessment of liver function in patients undergoing liver surgery. Since recent technology enables ICG-PDR to be measured noninvasively at the bedside, this parameter is an attractive addition to liver function and regional haemodynamic monitoring. However, the current state-of-the-art as concerns this technology remains at a low level of evidence and thorough assessment is required.

5. Conclusion

ICG elimination is a global function parameter that is dependent on liver perfusion, sinusoidal uptake, adenosine triphosphate-dependent excretion into biliary canaliculi and unrestricted biliary drainage, which should be considered and interpreted in an individual clinical context. Liver function quality and hepatic blood flow can be evaluated from the clearance of this non-toxic compound. However, the use of the test is carried out in only a few research centres and in clinical practice in few indications (such as the assessment of the liver function before resection). Since more recent technology enables noninvasive ICG-PDR measurement at the bedside, this parameter seems to be an attractive addition to liver function and regional haemodynamic diagnostic tools. In addition, the data suggest that assessing disease severity and outcome at a single time point is potentially fraught with difficulty. Instead, a ‘‘multistep’’ approach for complex patients that evolves with time and seeks to identify treatment ‘‘responders’’, might be advocated.