Published online Mar 8, 2016. doi: 10.4254/wjh.v8.i7.355
Peer-review started: March 25, 2015
First decision: May 18, 2015
Revised: February 1, 2016
Accepted: February 23, 2016
Article in press: February 24, 2016
Published online: March 8, 2016
Indocyanine green (ICG) kinetics (PDR/R15) used to quantitatively assess hepatic function in the perioperative period of major resective surgery and liver transplantation have been the object of an extensive, updated and critical review. New, non invasive bedside monitors (pulse dye densitometry technology) make this opportunity widely available in clinical practice. After having reviewed basic concepts of hepatic clearance, we analysed the most common indications ICG kinetic parameters have nowadays in clinical practice, focusing in particular on the diagnostic and prognostic role of PDR and R15 in the perioperative period of major liver surgery and liver transplantation. As recently pointed out, even if of extreme interest, ICG clearance parameters have still some limitations, to be considered when using these tests.
Core tip: Non invasive monitors for indocyanine green (ICG) clearance (PDR and R15) are now available for a rapid assessment of liver function both in the intensive care unit and in major liver surgery. After having reviewed the basic concepts of hepatic clearance, we have analysed the most common indications of ICG kinetic parameters in clinical practice, focusing on the diagnostic and prognostic role of PDR and R15 in the perioperative period of major resective liver surgery and liver transplantation. Since ICG parameters have still some limitations, we will underline the conditions (mainly hyperbilirubinemia and severe peripheral hypoperfusion) able to alter the reliability of these tests.