Purpose: Liver failure is a major cause of early mortality followinghepatectomy. The future-remnant liver function is an important factor whenassessing the risk for postoperative liver impairment. Several techniques havebeen established for this evaluation, including the ICG test. Aim of the study isto evaluate the ICG clearance in patients scheduled for liver resectionregarding perioperative and postoperative risk factors.Methods: Thirty-one patients, scheduled for liver resection, underwent theICG test. Peri-operative and postoperative variables were recorded andanalyzed using non-parametric tests.Results: Procedures extended from wedge excisions to extendedhepatectomies. Major complications included 1 case of a non-ST elevationmyocardial infarct, 1 case of inferior vena cava thrombosis, 2 cases of liverinsufficiency and 1 case of renal failure. Two patients died due to myocardialinfarction and postoperative liver failure respectively. PDR was foundpositively correlated with total blood loss, transfusion and operation duration.Conclusions: The role of residual liver function and particularly the hepaticreserve assessment on liver surgery may be of most benefit in the routinestratification of risk, enabling surgical procedures to be performed with safety.In this study, the ICG clearance markers were found significantly correlated with perioperative risk factors in histologically „normal‟ liver parenchyma.Interpretation of ICG clearance results may appraise in these patients aninadequate hepatic reserve in the remaining parenchyma postoperatively.Thus, in addition to CT volumetry, functional assessment of the hepaticreserve with ICG may persuade the preoperative planning and preventpostoperative liver failure.
Successful treatment of a case of acute liver failure and disseminated intravascular coagulation induced by heat stroke with plasma exchange and continuous hemodiafiltration
