Yasuhiko Sugawara

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.

Liver Biopsy in Transplantation: Nonalcoholic Fatty Liver Disease and the Eosinophils

Liver biopsy is important in the perioperative management of liver transplantation with regard to the preoperative evaluation of donor liver graft, especially to rule out steatotic liver, and the postoperative diagnosis of acute cellular rejection (ACR), especially to differentiate ACR from other causes of liver dysfunction. In both situations, liver biopsy is mandatory to confirm the diagnosis. The recent increases in metabolic syndrome and diabetes mellitus in the general population have led to an increased incidence of liver steatosis, even in donors without a history of excessive alcohol intake. Nonalcoholic fatty liver disease (NAFLD) includes a broad spectrum of liver injuries that resemble alcoholic hepatitis, ranging from simple steatosis to nonalcoholic steatohepatitis (NASH). NASH is the progressed stage of NAFLD and further progression results in fibrosis and cirrhosis, which might also be an indication for liver transplantation. ACR is one of the most serious adverse events after transplantation. It is often difficult to distinguish it from recurrent hepatitis C virus (HCV), and prompt treatment with an appropriate diagnosis is important. In this chapter, the indications for liver biopsy and the histologic findings for the diagnosis of NAFLD and ACR are described.