Internal and external validation of indocyanine green plasma disappearance rate to discard liver grafts before procurement

Sergio Cortese; Katherine Plua; Alejandro J. Perez-Alonso; María Savoie Hontoria; David Pacheco; Natalia Zambudio Carroll; Manuel Ángel Barrera Gómez; José María Pérez Peña; Álvaro G. Morales Taboada; María Fernández Martínez; Sergio Hernández Kakauridze; Ana María Matilla; José Ángel López Baena; José Manuel Asencio

doi:10.14701/ahbps.24-086

Ann Hepatobiliary Pancreat Surg

Published online June 20, 2024; https://doi.org/10.14701/ahbps.24-086

Sergio Cortese^1,2, Katherine Plua³, Alejandro J. Perez-Alonso⁴, María Savoie Hontoria⁵, David Pacheco³, Natalia Zambudio Carroll⁴, Manuel Ángel Barrera Gómez⁵, José María Pérez Peña¹, Álvaro G. Morales Taboada^1,2, María Fernández Martínez^1,2, Sergio Hernández Kakauridze^1,2, Ana María Matilla¹, José Ángel López Baena^1,2,6, José Manuel Asencio^1,2,6

¹Liver Transplant Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain,
²Department of General and Digestive Surgery, Hospital General Universitario Gregorio Marañón, Madrid, Spain,
³Hospital Universitario Río Hortega, Valladolid, Spain,
⁴Liver Transplant and HPB Surgery Unit, Department of General and Digestive Surgery, Hospital Virgen de las Nieves, Granada, Spain,
⁵Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain,
⁶Department of Medicine, Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain

Correspondence to: Sergio Cortese, MD
Hospital General Universitario Gregorio Marañón, C. Doctor Esquerdo 46, Madrid 28007, Spain
Tel: +34-653791459, Fax: +34-915868657, E-mail: sergio.cortese@hotmail.com
ORCID: https://orcid.org/0000-0003-1645-2143

Received April 5, 2024; Revised April 18, 2024; Accepted April 29, 2024.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract: Backgrounds/Aims: Thirty percent of liver grafts in donors after brain death (DBD) in Spain are rejected by procurement surgeons owing to marginal graft quality. Poor donor indocyanine green (ICG) clearance has been associated with graft discard and malfunction. This study aimed to internally and externally validate the predictive value of ICG-plasma disappearance rate (ICG-PDR) to reject grafts before donation and set a cut-off to avoid missing any potential effective donors.
Methods: Between March 2017 and August 2023, ICG clearance test was performed immediately before procurement in 71 DBD. The surgeon was blinded to test results. Univariate and multivariate analyses were performed to detect independent predictors of graft discard. Discrimination and calibration of predictors were assessed and a cut-off with 100% specificity was set. External validation was performed on 17 donors evaluated by three other transplantation teams.
Results: In the training cohort, 30 of 71 grafts were discarded for transplantation. ICG-PDR was the only donor variable independently associated with graft discard. The area under receiver operating characteristic curve for ICG-PDR was 0.875 (95% confidence interval: 0.768–0.947) and good calibration was observed. Below a PDR of 13.5%/min, no graft was accepted for transplantation. These results were successfully validated using the external cohort of donors.
Conclusions: ICG clearance test performed in DBD was internally and externally validated to predict liver graft discard. It could be used as a screening tool before donation to avoid unnecessary costs of travel and human resources.; Keywords : Donor selection; Brain death; Indocyanine green; Delayed graft function; Spain