Combination of Indocyanine green clearance test and remnant liver volume for safe major hepatectomy

Original Research


Introduction: Indocyanine green (ICG) clearance and remnant liver volume (RLV) are the two important factors in predicting post-hepatectomy liver failure (PHLF) after major hepatectomy; however, the combination of these is still controversial. This study is to find a way to combine these to select candidates for safe major hepatectomy.

Methods: A prospective cohort study included 137 major hepatectomies. ICG clearance (through ICG remnant at 15 minutes: ICG-R15), liver function results and the ratio of remnant to standard liver volume (RLV/SLV) were analyzed to examine their relations to PHLF. These variables, gender and age were analyzed using multivariate logistic regression to establish a model to predict PHLF.

Results: PHLF rate after major hepatectomy was 16.8% with 5.8% for grade B-C. ICG-R15 and RLV/SLV were significantly associated with PHLF (p = 0.019 and 0.007 respectively). ICG-R15 was not significantly associated with the grade of PHLF while RLV/SLV was but the post-hoc analysis showed no significant difference. Group RLV/SLV < 40% tended to have higher rate and grade of PHLF than group RLV/SLV > 40% but the difference was not significant (p = 0.063 and 0.072 respectively). Based on gender, age, ICG-R15 and RLV/SLV, PHLF rate could be estimated with model performance of 77%.

Conclusion: ICG clearance and RLV were associated with PHLF after major hepatectomy. It was safe and feasible to perform major hepatectomy with RLV/SLV under 40% and good ICG-R15. It was possible to estimate PHLF rate based on the patients’ gender, age, ICG-R15 and RLV/SLV. 

Graphical abstract