Indocyanine Green Clearance as a Tool to Predict Postoperative Liver Failure and Major Complications: First Systematic Review of Current Literature and Meta-analysis

Purpose: Perioperative liver function evaluation with indocyanine green (ICG) has been widely used in Asian countries. This study aims to review current strategies for postoperative failure (PLF) assessment ICG patients undergoing hepatectomy or transplant. Method: A systematic was performed according PRISMA guidelines. PubMed, Scopus, WoS, and Cochrane Library were searched up 2021. The primary outcome measure PLF. As a secondary outcome, major complications defined by Clavien-Dindo III-V grades assessed. Quantitative analysis random-effects model studies reporting similar methods. Results: is the first date. Out of 1674 studies, 40 included review. Most prospective (21/40) from Asia (23/40). Of 31 including hepatectomies, only 15 reported PLF ISGLS criteria. 94% preoperatively, though some combined intraoperative and/or use. 77% them obtained significant results recommended its For resection, preoperative ICG-R15>15% most frequent cut-off related transplant, early ICG-PDR<12%/min generally worse outcomes. Meta-analysis over 4 478 hepatocarcinoma. pooled MD ICG-R15 between without 0.59 (95% CI: 0.16-1.03; I2=64%). Finally, 3 after No association (OR 0.8; 95% 0.47 - 1.35; I2=83%) found. Conclusion: Literature suggests clearance useful non-invasive method predict surgery. However, due different parameters variable usage methods across global consensus should be defined.