Lactate blood levels in the perioperative period of orthotopic liver transplantation
- 102 Downloads
To investigate whether early postoperative changes in blood lactate concentration indicate the functional recovery of the newly grafted liver, changes in oxygen supply, oxygen consumption, acid-base equilibrium, and blood lactate concentrations were prospectively studied in a group of 53 postnecrotic cirrhotic patients during the various phases of orthotopic liver transplantation (preanhepatic, anhepatic, neohepatic) and for the first 48 h following reperfusion. The patients were divided into two groups according to the quality of the early graft function, as indicated by alanine aminotransferase, bile flow, and prothrombin activity: group A (49 patients), good immediate graft function and group B (4 patients), immediate graft non-function. Lactate levels rose in the same manner during the preanhepatic and anhepatic stages and peaked after revascularization of the graft. Following reperfusion, however, distinctly different blood lactate profiles were recorded in the two groups of patients. A fall in lactate concentration was recorded in group A patients, whereas a continuous rise occurred in group B patients: the difference becoming significant by the end of surgery (P<-0.05). During the first 48 h following revascularization of the graft, opposite trends in lactate concentration, bile flow, alanine aminotransferase, and prothrombin activity were evident in the two groups of patients: 24 h after reperfusion, lactate levels were below 2 mmol/1 in 47 of 49 patients from group A, while they plateaued above 4 mmol/1 in all patients from group B. Group A patients had lower alanine aminotransferase levels (P<-0.001), higher prothrombin activity, (P<-0.01), and greater bile flow (P<-0.02). If validated in larger series, the blood lactate profile, probably more than the absolute level, appears to be a useful indicator of the early recovery of liver metabolic capacities in the immediate postoperative period of orthotopic liver transplantation.
Key wordsOrthotopic liver transplantation Blood lactate levels Perioperative period Functional recovery
Unable to display preview. Download preview PDF.
- 3.Vincent JL. Lactic acidosis: diagnosis and treatment. In: A. Gullo, ed. Proceedings of APICE, 10th edn. Berlin Heidelberg New York: Springer; 1995:59–70.Google Scholar
- 4.Hawker F. The liver: anatomy physiology, biochemistry. London: Saunders 1993.Google Scholar
- 9.Moreau R. Oxygen transport and consumption in cirrhosis. In: Bomzon A, Blendis LM, eds. Cardiovascular complications of liver disease. Boca Raton: CRC Press; 1990:226–238.Google Scholar
- 11.Kang YG, Gelman S. Liver transplantation. In: Gelman S, ed. Anesthesia and organ transplantation. London: Saunders 1987: 139–185.Google Scholar
- 16.McGinty M, Cottam S, Pannell M, Milroy S, Oyesola B, Potter D. Can intraoperative serum lactate levels predict early graft function following liver transplantation? (abstract) Liver Transplant Surg 1995; 1:440.Google Scholar
- 18.Koller J, Wieser C, Furtwangler W, Kornberger R, Konigsrainer A, Margraiter R. Orthotopic liver transplantation and perioperative lactate metabolism. Proceedings of first ILTS Conference; Pittsburgh. Transplantat Proc 1991 ; 23:1989–1990.Google Scholar