Potential factors dedicated to postoperative liver dysfunction in patients with normal preoperative ICG-15 clearance rate

摘要

To the Editor, The indocyanine green (ICG) clearance test has been widely used to assess the dynamic liver function and has been suggested as a major predictor of postoperative liver dysfunction in chronic liver disease (CLD) patients who receive hepatic resection. ICG excretion rate in bile reflects the hepatic excretory function and hepatic energy status. However, it must be emphasized that ICG is represented by hepatocytes, its excretion into the bile, liver blood flow and energy status. Postoperative liver dysfunction is a major source of the increased risk of morbidity and mortality in CLD patients undergoing liver resection . Generally speaking, healthy livers usually reveal a normal ICG of <10 . Although a level of 20 is regarded as safe for extended hepatectomy in CLD patients with hepatocellular carcinoma (HCC) , a patient in our medical unit suffered a fatal portal hypertension and acute liver failure after caudate lobectomy and died because of multiple organ dysfunction symptoms. A 40-year-old male patient with a solitary caudate lobe HCC was admitted to our hospital and preoperative compensate liver function was evaluated for the following reasons: (1) normal TB, ALB and PT levels; (2) ICG in 15 min test was 5.9 %; and (3) absence of ascites.