Abstract：
UNASSIGNED: Thirty percent of liver grafts in donors after brain death (DBD) in Spain are rejected by procurement surgeons owing to marginal graft quality. Poor donor indocyanine green (ICG) clearance has been associated with graft discard and malfunction. This study aimed to internally and externally validate the predictive value of ICG-plasma disappearance rate (ICG-PDR) to reject grafts before donation and set a cut-off to avoid missing any potential effective donors.
UNASSIGNED: Between March 2017 and August 2023, ICG clearance test was performed immediately before procurement in 71 DBD. The surgeon was blinded to test results. Univariate and multivariate analyses were performed to detect independent predictors of graft discard. Discrimination and calibration of predictors were assessed and a cut-off with 100% specificity was set. External validation was performed on 17 donors evaluated by three other transplantation teams.
UNASSIGNED: In the training cohort, 30 of 71 grafts were discarded for transplantation. ICG-PDR was the only donor variable independently associated with graft discard. The area under receiver operating characteristic curve for ICG-PDR was 0.875 (95% confidence interval: 0.768-0.947) and good calibration was observed. Below a PDR of 13.5%/min, no graft was accepted for transplantation. These results were successfully validated using the external cohort of donors.
UNASSIGNED: ICG clearance test performed in DBD was internally and externally validated to predict liver graft discard. It could be used as a screening tool before donation to avoid unnecessary costs of travel and human resources.
UNASSIGNED: Between March 2017 and August 2023, ICG clearance test was performed immediately before procurement in 71 DBD. The surgeon was blinded to test results. Univariate and multivariate analyses were performed to detect independent predictors of graft discard. Discrimination and calibration of predictors were assessed and a cut-off with 100% specificity was set. External validation was performed on 17 donors evaluated by three other transplantation teams.
UNASSIGNED: In the training cohort, 30 of 71 grafts were discarded for transplantation. ICG-PDR was the only donor variable independently associated with graft discard. The area under receiver operating characteristic curve for ICG-PDR was 0.875 (95% confidence interval: 0.768-0.947) and good calibration was observed. Below a PDR of 13.5%/min, no graft was accepted for transplantation. These results were successfully validated using the external cohort of donors.
UNASSIGNED: ICG clearance test performed in DBD was internally and externally validated to predict liver graft discard. It could be used as a screening tool before donation to avoid unnecessary costs of travel and human resources.
摘要：
■西班牙脑死亡（DBD）后供体中有30％的肝移植物由于移植物质量差而被采购外科医生拒绝。供体吲哚菁绿（ICG）清除率差与移植物丢弃和故障有关。这项研究旨在内部和外部验证ICG-血浆消失率（ICG-PDR）的预测值，以在捐赠前拒绝移植物，并设定一个截止值，以避免错过任何潜在的有效供体。
■在2017年3月至2023年8月之间，在71DBD中采购之前立即进行了ICG清除测试。外科医生对测试结果视而不见。进行单变量和多变量分析以检测移植物丢弃的独立预测因子。评估预测因子的辨别和校准，并设置具有100％特异性的截止值。对其他三个移植团队评估的17个供体进行外部验证。
■在培训队列中，71个移植物中的30个被丢弃用于移植。ICG-PDR是与移植物丢弃独立相关的唯一供体变量。ICG-PDR的受试者工作特征曲线下面积为0.875（95％置信区间：0.768-0.947），并且观察到良好的校准。低于13.5%/min的PDR，未接受移植。使用供体的外部队列成功地验证了这些结果。
■在DBD中进行的ICG清除率测试在内部和外部进行了验证，以预测肝移植物丢弃。它可以用作捐赠前的筛查工具，以避免不必要的旅行和人力资源成本。
■在2017年3月至2023年8月之间，在71DBD中采购之前立即进行了ICG清除测试。外科医生对测试结果视而不见。进行单变量和多变量分析以检测移植物丢弃的独立预测因子。评估预测因子的辨别和校准，并设置具有100％特异性的截止值。对其他三个移植团队评估的17个供体进行外部验证。
■在培训队列中，71个移植物中的30个被丢弃用于移植。ICG-PDR是与移植物丢弃独立相关的唯一供体变量。ICG-PDR的受试者工作特征曲线下面积为0.875（95％置信区间：0.768-0.947），并且观察到良好的校准。低于13.5%/min的PDR，未接受移植。使用供体的外部队列成功地验证了这些结果。
■在DBD中进行的ICG清除率测试在内部和外部进行了验证，以预测肝移植物丢弃。它可以用作捐赠前的筛查工具，以避免不必要的旅行和人力资源成本。
