Intraoperative blood lactate level as an early predictor of initial graft function in human living donor liver transplantation.
This study was performed to investigate whether intraoperative changes in blood lactate levels after hepatic allograft reperfusion reflect initial graft function in living donor liver transplantation (LDLT).


METHODS
From 1994 to 2003, 15 of LDLT cases were divided into two groups based on the intraoperative blood lactate levels. Group A consisted of seven recipients whose new liver grafts started to consume lactate immediately after portal perfusion. Group B consisted of the remaining eight recipients whose intraoperative blood lactate values showed no change or an elevation for 2 hours after graft revascularization.


RESULTS
All Group A patients survived, whereas three out of eight patients in Group B died of infection and portal vein thrombosis within 3 months after LDLT. There was no significant difference in preoperative donor and recipient laboratory data. The recipient age and body size in Group B were significantly higher than those in Group A, indicating that Group B consisted of small-for-size liver transplant cases. Serum total bilirubin concentrations in Group B were significantly higher than Group A from postoperative day 5 to 23, whereas postoperative liver enzyme levels and prothrombin time were similar between the two groups.


CONCLUSIONS
The change in intraoperative blood lactate after hepatic allograft reperfusion served as an accurate predictor of initial graft function which was associated with graft size in human LDLT.
Nishimura
A
A
Second Department of Surgery, Hirosaki University School of Medicine, Hirosaki, Aomori, Japan. h01gm503@cc.hirosaki-u.ac.jp
Hakamada
K
K
Narumi
S
S
Totsuka
E
E
Toyoki
Y
Y
Ishizawa
Y
Y
Umehara
M
M
Yoshida
A
A
Umehara
Y
Y
Sasaki
M
M
D000328:Adult; D015415:Biomarkers / Q000097:blood; D002675:Child, Preschool; D006801:Humans; D007773:Lactates / Q000097:blood*; D008111:Liver Function Tests; D016031:Liver Transplantation / Q000502:physiology*; D019520:Living Donors; D016343:Monitoring, Intraoperative / Q000379:methods; D015203:Reproducibility of Results; D012189:Retrospective Studies
D015415:Biomarkers; D007773:Lactates