Ann Hepatobiliary Pancreat Surg.  2025 Feb;29(1):32-37. 10.14701/ahbps.24-196.

Feasibility of indocyanine green fluorescence imaging to predict biliary complications in living donor liver transplantation: A pilot study

• Lee J
• Choi Y
• Yi NJ
• Kim JY
• Hong Sy
• Lee JM
• Hong SK
• Lee KW
• Suh KS

• KMID: 2565404
• DOI: http://doi.org/10.14701/ahbps.24-196

Abstract

Backgrounds/Aims
Liver transplantation (LT) is now a critical, life-saving treatment for patients with liver cirrhosis or hepatocellular carcinoma. Despite its significant benefits, biliary complications (BCs) continue to be a major cause of postoperative morbidity. This study evaluates the fluorescence intensity (FI) of the common bile duct (CBD) utilizing near-infrared indocyanine green (ICG) imaging, and examines its association with the incidence of BCs within three months post-LT.
Methods
This investigation analyzed data from nine living donor LT (LDLT) recipients who were administered 0.05 mg/kg of ICG prior to bile duct anastomosis. Real-time perfusion of the CBD was recorded for three minutes using an ICG camera, and FI was quantified using Image J (National Institutes of Health). Key parameters assessed included F max, F_1/2 max, T_1/2 max, and the slope (F max/ T max) to evaluate the fluorescence response.
Results
BCs occurred in two out of nine patients. These two patients exhibited the longest T_1/2 max values, which were linked with lower slope values, implicating a potential relationship between extended T_1/2 max, reduced slope, and the occurrence of postoperative BCs.
Conclusions
The study indicates that ICG fluorescence imaging may serve as an effective tool for assessing bile duct perfusion in LDLT patients. While the data suggest that an extended T_1/2 max and lower slope may correlate with an increased risk of BCs, further validation through larger studies is required to confirm the predictive value of ICG fluorescence imaging in this setting.

Keyword

Living donor liver transplantation; Indocyanine green fluorescence intensity; Biliary complications; T_1/2 max; Slope

Figure

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  Fig. 1 Changes in ICG fluorescence intensity over time. After administering 0.05 mg/kg of ICG, the recipient CBD (arrow) perfusion images were captured using an ICG fluorescence camera. (A) After 10 seconds. (B) After 20 seconds. (C) After 30 seconds. (D) After 40 seconds. ICG, indocyanine green; CBD, common bile duct.

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  Fig. 2 The ICG angiography images were analyzed at 10-second intervals using the Image J software program. The fluorescence intensity was measured in a 1 × 1 cm area (square), positioned as close as possible to the recipient`s CBD (dotted line) proximal margin. ICG, indocyanine green; CBD, common bile duct.

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  Fig. 3 Time–fluorescence curve of ICG angiography. F max, peak fluorescence intensity; F1/2 max, fluorescence intensity halfway between the baseline and F max; T1/2 max, the time at which the fluorescence intensity reaches F1/2 max; Slope, F max/T max.

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  Fig. 4 ICG fluorescence intensity at 10-second intervals over time. It illustrates two ICG fluorescence patterns: one with a rapid peak FI and high F max, and another with a delayed peak FI and lower F max. Post-LDLT BCs occurred in the latter group, with patients no. 7 and no. 9 exhibiting lower slopes and prolonged T1/2 max, indicating delayed CBD perfusion. ICG, indocyanine green; FI, fluorescence intensity; LDLT, living donor liver transplantation; BC, biliary complication; CBD, common bile duct.

Reference

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