Utility of ICG-Fluorescence in Laparoscopic Liver Living-Donor Transplantation

Background: Left lateral sectionectomy in a living donor is standard therapy for pediatric patients with liver failure or unresectable hepatic neoplasms. Depending on donor vascular anatomy, removal of the left hepatic artery (LHA) and left portal vein (LPV) with the transplant allograft may result in relative ischemia to segment IV of the donor liver. Aim: Present our center’s experience using intraoperative indocyanine green (ICG) fluorescence to assess donor liver vascularization during laparoscopic liver donation. Methods: Five cases of laparoscopic left lateral sectionectomy were performed at our center for pediatric LDLT 12/2021-10/2022. All donors underwent thin-slice multidetector computed tomography (MDCT) scan preoperatively. Intraoperatively, following dissection, isolation, and selective clamping of the LHA and LPV, ICG was administered (12.5 mg, i.v.) and the perfusion to the remnant liver visualized. Results: Overall, there was a relatively low correlation between expected line of ischemic demarcation based on preoperative MDCT and actual line of ischemic demarcation seen with intraoperative ICG fluorescence. Intraoperative ICG fluorescence was used to guide the plane of liver transection. All grafts were transplanted successfully, and all donors recovered well after surgery and were discharged home in 3-7 days. Conclusion: Apart from pre-operative cross-sectional imaging, intraoperative vascular clamping and indocyanine green (ICG) administration represent a useful tool to evaluate segment IV vascularization and guide surgical decision-making.