Future Liver Remnant Indocyanine Green Plasma Clearance Rate as a Predictor of Post-hepatectomy Liver Failure After Portal Vein Embolization

PurposeTo evaluate the utility of future liver remnant plasma clearance rate of indocyanine green (ICGK-F) for predicting post-hepatectomy liver failure (PHLF) compared with percentage future liver remnant volume-to-total liver volume ratio (%FLR) after portal vein embolization (PVE).Materials and MethodsPVE procedures in 20 patients (15 patients underwent PVE with absolute ethanol; 5 patients with gelatin particles) from 2010 to 2017 were analyzed. %FLR=future liver remnant volume (ml)/[total liver volume (ml)-tumor volume (ml)]x100; ICGK-F=plasma clearance rate of indocyanine green (ICGK)x%FLR/100 were calculated before and after PVE. PHLF was categorized according to the criteria of the International Study Group of Liver Surgery. For predicting PHLF, we compared the ICGK-F and %FLR after PVE between the grade A PHLF group and the non-grade A PHLF (grades B and C) group.ResultsAll PVE procedures were successful. While the ICGK-F of the grade A PHLF group (median 0.073, n=16) was about twice that of the non-grade A PHLF group (median 0.043, n=4), showing a significant difference (Mann-Whitney U test:P=0.002), there was no significant difference in %FLR between the grade A PHLF group and the non-grade A PHLF group (Mann-Whitney U test: P=0.335).ConclusionICGK-F was significantly higher in the grade A PHLF group than in the non-grade A PHLF group (grades B and C), and ICGK-F was more useful for predicting PHLF than %FLR.