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Significant role of intrahepatic shunt in hepatic function test with the use of dye in cirrhosis.

Using hepatic vein catheterization, fractional clearance (K) and hepatic extraction rate (ER) of Indocyanine Green (ICG) and radioisotope particles (RI) were studied in cirrhotic portal hypertension (24 postnecrotic cirrhotics and 25 alcoholic cirrhotics). ICG given intravenously is cleared from blood only by hepatocytes, whereas RI are uptaken by intrahepatic (Kupffer cells) and extrahepatic reticuloendothelial (RE) cells. Since there were significant positive correlations between K-ICG and K-RI in postnecrotic cirrhosis (r = 0.588, P < 0.01) and in alcoholic cirrhosis (r = 0.620, p < 0.01), and between ER-ICG and ER-RI in postnecrotic cirrhosis (r = 0.508, p < 0.02) and in alcoholic cirrhosis (r = 0.558, p < 0.01), the most reasonable explanation of these correlations was that significant amount of ICG and Rl given intravenously bypassed both Kupffer cells and hepatocytes in the patients with portal hypertenaion due to cirrhosis. Therefore, liver function test with the use of dye, such as ICG, is influenced significantly by intrahepatic shunt bypassing hepatocytes in cirrhosis.