Applications of Indocyanine Green Fluorescence Imaging to Liver Transplantation

Recently, fluorescence imaging using indocyanine green (ICG) has been applied to hepatobiliary surgery. Herein, the clinical applications of ICG fluorescence imaging in cases of liver transplantation are described. First, concomitant use of fluorescence cholangiography following intrabiliary injection of ICG by conventional radiographic cholangiography is useful for determination of the division point of the hepatic duct during donor surgery. Secondly, fluorescence angiography can be used to evaluate the hepatic blood flow after venous reconstruction in recipient surgery. Lastly, ICG fluorescence imaging enables simple and easy evaluation of the portal uptake function in hepatic regions with venous occlusion caused by the division of the major hepatic vein tributaries, information about which is helpful for surgeons to determine the operative indication and need for venous reconstruction, not only in liver transplantation, but also in major hepatic resections for malignancy.