Preoperative assessment of chemotherapeutic associated liver injury based on indocyanine green retention test

• ICG test can predict the diagnosis of SOS but does not give any information on nodular regenerative hyperplasia and steatohepatitis.
• High preoperative ICGR15 values are more common in elderly male patients and after bevacizumab administration.
• High preoperative ICGR15 values not represent a contraindication to liver surgery.

BackgroundThe aim of the study was to assess the capacity of indocyanine green retention test at 15 min (ICGR15) to predict chemotherapeutic-associated liver injuries (CALI).MethodsPatients undergoing liver resection for CLM that received preoperative oxaliplatin and/or irintecan-based chemotherapy within 3 months before surgery and scheduled first hepatectomy were considered.Results166 out of 983 patients treated between 01/2001 and 04/2014 fulfilled the inclusion criteria. The median number of cycles of preoperative chemotherapy was 6.0 ± 4.87. Chemotherapy was mainly based on oxaliplatin in 123 (74.1%). Bevacizumab was associated in 51(31%) patients. A total of 102 (61.4%) patients had at least 1 CALI. Grade 2–3 steatosis occurred in 56 (33.7%) patients and steatohepatitis in19(11.5%). Sinusoidal obstructive syndrome (SOS) was presented in 93 (56%) patients. 23(13.8%) patients had nodular regeneration hyperplasia. At multivariate analysis the only predictive factor of ICGR≥10% was age≥65 years (p = 0.001). A median split (ICGR15 = 8%) was used to categorized ICGR15 value. Multivariate analysis showed that age≥ 65 [OR 2.530 (CI95% 1.28–4.97) p < 0.001], male sex [OR 2.614 (CI95% 1.31–5.20) p < 0.001], SOS [OR 1.954 (CI95% 1.00–3.81) p = 0.050] and administration of Bevacizumab [OR 2.201 (CI95% 1.07–4.50) p = 0.031] were predictive factors for ICGR≥8%.ConclusionsICGR15 test can predict the diagnosis of SOS. High ICGR15 value is more common in elderly male patients and after bevacizumab administration.