Preliminary Study On The Clinical Importance Of The Combined Application Of 2D SWE And ICG In The Assessment Of Donor Liver Quality

Objective:To explore the clinical value of two-dimensional shear wave elastography(2D SWE)combined with indocyanine green(ICG)text to evaluate the function and quality of donors' liver.Methods:A retrospective analysis of 88 cases of organ donors in our hospital from May 2018 to December 2018.ICG and 2D SWE examinations were performed on 21 organ donors before liver acquisition,Seven donors completed the ICG examination alone,and 60 donors alone completed the 2D SWE examination.Collect and record the total bilirubin,prealbumin,cholinesterase,international normalized ratio,prothrombin time and histopathology before transplantation,and record the recipient's lactate recovery time(d),ICU stay time(d),liver function recovery time(d),prothrombin recovery time(d),cholinesterase recovery time(d);the first postoperative recipient Days,1 week,2 weeks,3 weeks of glutamic-pyruvic transaminas,glutamic oxalacetic transaminase,total bilirubin;the prothrombin time,international standardized ratio on the 1st,2nd,and 3rd days postoperation,and the T-tube bile drainage on the 1st,2nd,and 3rd days after the operation.According to the early recovery of liver function of the recipient,it was divided into an early allograft dysfunction(EAD)group and an early liver function recovery normal group.Analyze and compare the difference of ICG and 2D SWE between the two groups.And use receiver operating characteristic curve(receiver operating characteristic,ROC)to compare and analyze the prediction effect of different indicators on EAD.Results:The ROC analysis of the data of 21 donors who completed the ICG test and 2D SWE simultaneously showed that the area under curve of the 2D SWE was 0.756(95% CI:0.5392-0.9719,P>0.05),The area under curve of the ICG-PDR was 0.789(95% CI:0.5126-1,P<0.05),the area under curve of the ICG-R15 was 0.767(95% CI:0.4902-1,P>0.05).The area under curve used by 2D SWE and ICG to predict postoperative EAD is: ICG + 2D SWE: 0.822(95% CI:0.6078-1;P<0.05).ROC analysis of the SWE value of 81 donors showed that the area under curve of the SWE was 0.715(P <0.05,the best cutoff value 4.35 kPa,sensitivity 85.7%,specificity 53.3%).ROC analysis of ICG data of 28 donors showed that the area under curve was 0.789(P <0.05,the best cutoff value 21.7% / min,sensitivity 85.7%,specificity 85.7%),area under the curve of ICG-R15 was 0.772(P <0.05,the best cutoff value 4.15%,sensitivity 85.7%,specificity 81%).In the EAD group and the non-EAD group,the value of ICG-R15 in the donor liver was: 5.48 ± 3.03% vs 3.21 ± 1.42%;the difference between the two groups was statistically significant(P <0.05).Correlation analysis of ICG R15,ICG PDR,2D SWE and more than 30 indicators of donors and recipients.The results showed that: ICG-PDR was negatively correlated with the donor 's international normalized ratio(INR)(r =-0.385,p <0.05),and the other indicators were not significantly correlated(P > 0.05).Conclusion: 2D SWE combined with ICG can predict the occurrence of EAD,and there is a weak correlation between ICG-PDR and INR.The two have the advantages of non-invasive,simple,fast,easy to master,and quantitative evaluation.The combination of the two can partially replace the subjective judgment of the transplant surgeon and is an effective method to evaluate the quality of the donor liver.