Markers of cellular dysoxia during orthotopic liver transplantation in pigs.
OBJECTIVE
To characterize global, regional, and end-organ markers of cellular dysoxia during orthotopic liver transplantation and early reperfusion in pigs.


METHODS
Descriptive study.


METHODS
University hospital research laboratory.


METHODS
7 fasted, anesthetized, and mechanically ventilated Yorkshire pigs underwent orthotopic liver transplantation. Oxygen consumption (VO2) and oxygen delivery (DO2) were both calculated using standard formulae. Gastric interstitial pH and the gastroarterial partial pressure of carbon dioxide (PCO2) gradient were measured with a gastric tonometer. The following were determined from arterial blood samples: serum lactate to pyruvate ratio, serum 3-hydroxybutyrate to acetoacetate ratio, plasma free fatty acids, and plasma free and total carnitine levels.


RESULTS
Data were collected 1 h after induction of anesthesia (I), at the end of the anhepatic phase (A), and 1 h after reperfusion (R), Median (range) VO2 values obtained at the specified time points were: I 318 (206-1860), A 210 (152-408), R 330 (214-424) ml/kg per min, respectively (NS); DO2 values were: I 1828 (1382-3259), A 1219 (452-2492), R 1741 (1345-12,071) ml/kg per min, respectively (NS). The lactate to pyruvate ratio, reflecting the redox potential of the cytosol, progressively increased: I 22 (9-46), A 29 (16-68), R 43 (23-55), (p < 0.05). Gastric interstitial pH, as well as the gastroarterial PCO2 gradient values at the specified time points did not reach statistical significance. Levels of ketone bodies (3-hydroxybutyrate+acetoacetate) remained lower than 0.120 mmol/l. The ketone body ratio did not significantly vary over time (NS). Plasma esterified and free carnitine concentrations and free fatty acid values remained within normal limits (NS). Among these markers, the ketone body ratio presented the largest area under the receiver operating characteristic curve as a marker of postoperative mortality, with an inflexion point at 0.9.


CONCLUSIONS
In this study, orthotopic liver transplantation was associated with significant variations over time in the redox potential of the cytosol. Postoperative mortality was, however, related to the redox state of the liver mitochondria. Our data suggest the occurrence of abnormal tissue oxygenation during liver transplantation.
de Jaeger
A
A
Division of Critical Care, Ste. Justine Hospital, University of Montreal, Canada.
Proulx
F
F
Yandza
T
T
Dugas
M A
MA
Boeuf
B
B
Manika
A
A
Lacroix
J
J
Lambert
M
M
D020155:3-Hydroxybutyric Acid; D000090:Acetoacetates / Q000097:blood; D000818:Animals; D015415:Biomarkers / Q000097:blood; D002331:Carnitine / Q000097:blood; D015687:Cell Hypoxia / Q000502:physiology*; D003600:Cytosol / Q000378:metabolism; D004195:Disease Models, Animal; D005230:Fatty Acids, Nonesterified / Q000097:blood; D005260:Female; D006801:Humans; D006885:Hydroxybutyrates / Q000097:blood; D019344:Lactic Acid / Q000097:blood; D016031:Liver Transplantation / Q000009:adverse effects* / Q000401:mortality / Q000502:physiology*; D010084:Oxidation-Reduction; D010101:Oxygen Consumption; D019289:Pyruvic Acid / Q000097:blood; D012372:ROC Curve; D013552:Swine; D013997:Time Factors
D000090:Acetoacetates; D015415:Biomarkers; D005230:Fatty Acids, Nonesterified; D006885:Hydroxybutyrates; D019344:Lactic Acid; C016635:acetoacetic acid; D019289:Pyruvic Acid; D002331:Carnitine; D020155:3-Hydroxybutyric Acid