# Dynamic Liver Function Tests in Paediatric Liver Disease

## TL;DR

This study shows that dynamic liver function tests like ICG clearance and HBS are useful in children with liver disease and correlate with conventional markers.

## Contribution

The study evaluates the association between ICG clearance and HBS in children with liver disease, identifying their correlation with liver function markers.

## Key findings

- ICG plasma disappearance rate strongly correlates with hepatic extraction fraction (ρ = 0.64, p < 0.001).
- ICG clearance and HBS are associated with liver injury, reduced synthetic function, cholestasis, cirrhosis, and portal hypertension.
- Liver transplantation is linked to increased HBS parameters but not ICG clearance.

## Abstract

Background/Objectives: Liver function is difficult to estimate accurately. Conventional liver function tests can be normal, even in severe diseases. Dynamic liver function tests, including indocyanine green (ICG) clearance and hepatobiliary scintigraphy (HBS), are useful in adults. We aimed to evaluate the association between ICG clearance and HBS in children with liver disease and to identify liver disease markers associated with liver function measured with ICG clearance and HBS. Methods: Children aged 0–18 years followed at Copenhagen University Hospital, Rigshospitalet between November 2015 and August 2024 were eligible for inclusion if they had acute or chronic liver disease, suspected liver disease, or previous liver transplantation (LTx). All underwent ICG clearance and HBS. Results: We included 131 children with a total of 200 visits. The median visit age was 11.4 [6.6; 15.6] years. The ICG-plasma disappearance rate had the strongest correlation with the hepatic extraction fraction (ρ = 0.64, p < 0.001). ICG clearance and HBS were associated with liver injury, reduced synthetic function, cholestasis, cirrhosis, and portal hypertension, while only ICG clearance was associated with the portal blood flow. LTx was associated with increased HBS parameters, but not with ICG clearance. Conclusions: ICG clearance and HBS are correlated, and both are associated with most conventional liver function markers. This suggests their usefulness in evaluating children with liver disease. However, further evaluation of the predictive and clinical value of ICG clearance and HBS in disease progression is needed.