Early Graft Dysfunction Evaluation by Indocyanine Green Plasma Clearance Rate in the Immediate Postoperative Period After Liver Transplantation Esteban Horacio Gonzalez, Lucas Souto Nacif*, Alex Jones Flores Cassenote, Rafael Soares Pinheiro, Vinicius Rocha-Santos, Rodrigo Bronze de Martino, Daniel Reis Waisberg, Rubens Macedo Arantes, Liliana Ducatti, Luciana Haddad, Flávio Galvão, Wellington Andraus, and Luiz Carneiro D’Albuquerque Liver and Gastrointestinal Transplant Division, Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo, Brazil ABSTRACT Background. Liver transplantation (LT) has evolved to improve graft and patient sur- vival. Early graft dysfunction (EGD) and primary nonfunction are an important cause of morbi-mortality. We had formulated the scientific hypothesis that the liver function can be evaluated by the indocyanine green (IG) after LT. The aim was to evaluate the EGD by plasma disappearance rate (PDR) of IG after LT. Method. Prospective and observational clinical study, from July 2014 to June 2015. IG evaluation by pulse densitometry, Limon system. Degree analysis of ischemia and reper- fusion injury in groups as follows: 1 (G0/G1/G2) and 2 (G3/G4). Donor risk index (DRI), Wagener and Olthoff criteria, and prognostic predictors were evaluated. All tests were performed with bidirectional a of 0.05 and a confidence interval of 95% and support by IBM SPSS 25. Results. A total of 40 patients, mean age 53.3  14.0 years and a majority of men and hepatitis C virus. PDR were more relevant with high degrees of ischemia and reperfusion injury grades G3/G4 (P ¼ .030). The PDR related to the donor risk index showed positive significance at DRI >1.5 (P ¼ .066). The retention rate of IG at 15 minutes demonstrated potential in assessing graft loss or death (P ¼ .063). Conclusion. EGD can be assessed by PDR with high degrees of ischemia and reperfusion injury (G3/G4) and with marginal donors (DRI >1.5). The retention rate of IG at 15 minutes demonstrated potential in assessing graft loss or death of the patient. L IVER transplantation (LT) has evolved in recent de- cades improving graft and patient survival. Important cause of morbidity and mortality is early graft dysfunction and primary nonfunction [1,2]. Several biomarkers have been studied, but there is no consensus. Early graft dysfunction (EGD) after liver transplantation is consistently associated with poor clinical outcomes [3]. Although, the indocyanine green (IG) has been described as a marker for both hepatic function and perfusion [4]. Furthermore, there were no previous studies evaluating its performance in comparison with the Wagener, Olthoff, donor risk index (DRI) scores, and analysis of ischemia and reperfusion injury in the immediate postoperative period after liver transplantation Thereby, we had formulated the scientific hypothesis to evaluate and quantify the liver function by the IG after liver *Address correspondence to Lucas Souto Nacif, MD, PhD, Liver and Gastrointestinal Transplant Division, Department of Gastroenterology, University of São Paulo School of Medicine, Dr. Enéas de Carvalho Aguiar, 255, 9  andar, sala 9113/9114, São Paulo 05403-900, Brazil. Tel: (55 11) 2661-3323; Fax: (55 11) 2661-9007. E-mail: lucasnacif@usp.br ª 2020 Elsevier Inc. All rights reserved. 230 Park Avenue, New York, NY 10169 0041-1345/20 https://doi.org/10.1016/j.transproceed.2020.02.025 Transplantation Proceedings, XX, 1e4 (2020) 1