Background: Liver transplantation (LT) is the gold standard for end-stage liver disease, yet postoperative complications challenge patients and physicians. Indocyanine green (ICG) clearance, a quantitative dynamic test of liver function, is a rapid, reproducible, and reliable test of liver function. This study aimed to systematically review and summarize current literature analyzing the association between ICG tests and post-LT outcomes.

Results: Six studies conducted between 1994 and 2018 in Europe, America, and Asia were included. The study population ranged from 50 to 332 participants. ICG clearance on the first postoperative day was associated with early allograft dysfunction (EAD), graft loss, 1- and 3-mo patient survival probability, prolonged intensive care unit (ICU), and hospital stay. The dichotomized ICG plasma disappearance rate (PDR) provided a strong association with medium- and long-term outcomes: PDR<10%/min with 1-month mortality or re-transplantation (Odds Ratio (OR): 7.89, 95% confidence interval (CI) 3.59-17.34, P<0.001) and PDR<16.0%/min with 3-month patient survival probability (Hazard ratio (HR): 13.90, 95% CI 4.67-41.35, P<0.01). The preoperative model for end-stage liver disease and body mass index were independent prognostic factors for EAD, early complications, and prolonged ICU stay; post-LT prothrombin time and INR were independently associated with graft loss and bilirubin with a prolonged hospital stay.

Conclusion: This review shows that ICG clearance tests are associated with graft function recovery, suggesting that a potential prognostic role of ICG test, as an aid in predicting the post-LT course, could be considered.

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