Indocyanine green clearance

The clearance of indocyanine green can provide an estimate of hepatic perfusion as uptake is almost exclusively from hepatocytes and the extraction ratio is high. As the extraction ratio of this compound across the liver approximates to almost unity, its clearance can also be used as a marker of function ( Caesarefal 1.9.61).

Therefore interpretation of this test must take into account the varying effects of both liver blood flow and hepatic extraction. In order to quantify the extraction ratio in patients with liver dysfunction, it is necessary to sample indocyanine green concentrations across the liver from the hepatic vein and a peripheral artery. When high levels of indocyanine green are given, the uptake process becomes saturated and the maximal clearance, which equates to the functioning mass of hepatocytes, can be calculated. Reports have suggested that this test can be used as an independent variable in the assessment of prognosis for patients with cirrhosis, in patients awaiting liver transplantation, and in the assessment of potential donor grafts.

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