The safety of indocyanine green in patients with advanced chronic kidney disease or kidney transplantation: a scoping review

Abstract

Near-infrared fluorescence imaging with indocyanine green (ICG) is increasingly being used in the field of image-guided surgery. Although ICG is considered non-nephrotoxic in current literature, caution is advised for the use of ICG in patients with advanced chronic kidney disease (CKD), including kidney transplant recipients. Therefore, a scoping review was performed to assess the safety of ICG in patients with advanced CKD or a renal allograft. This scoping review was guided by the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-analyses Extension for Scoping Reviews). Web of Science, PubMed, and Embase were searched for articles and abstracts in which ICG was administered in patients with CKD or a renal allograft. The extracted data included the incidence of adverse events, kidney function after injection of ICG, preservation of transplant function, and type of other possible complications. The initial search resulted in 635 records of which 19 studies were found eligible for the review. ICG was used for multiple purposes but never specifically as an objective to investigate possible nephrotoxicity. No adverse events were reported in the transplant group (n=250) or the CKD group (n=74). Despite ICG-injection, preservation of transplant function after transplantation surgery was 94% in 198 patients, and no increase in possible ICG-related other complications was reported. This scoping review found no evidence that ICG increases the risk of adverse events in patients with CKD, including kidney transplant recipients. Therefore, the administration of ICG should not be withheld from these patients.

Keywords: chronic kidney disease; fluorescent dyes; indocyanine green; kidney transplantation; near-infrared fluorescence imaging.

Figure 1.

Preferred Reporting Items for Systematic Review and Meta-Analysis extension for Scoping reviews (PRISMA-ScR, Supplemental Digital Content 1, http://links.lww.com/MS9/A641) flow diagram. Screening and eligibility for studies on the use of ICG in patients with renal insufficiency or renal transplantation. CKD, chronic kidney disease; ICG, indocyanine green.