title: Can joint analysis of postoperative MELD, base excess and blood lactate levels be used as an index of postoperative outcome for patients submitted to liver transplantation?
abstract: OBJECTIVE
  The objective of the present study was to evaluate the postoperative levels of classical or pure MELD and changes in lactate or base excess (BE) levels as possible predictive factors of the type of outcome of patients submitted to orthotopic liver transplantation (OLT).
  
  
  METHODS
  The study was conducted on 60 patients submitted to OLT at the University Hospital, Faculty of Medicine of Ribeirão Preto, USP, between October 2008 and March 2012. The 30 latest survivor (S) and non-survivor (NS) cases were selected. All liver transplants were performed using the piggy-back technique. ALT, AST, BE and blood lactate values were determined for each group at five time points (immediate preoperative period, end of hypothermal ischemia, 5 and 60 minutes after arterial revascularization and in the immediate postoperative period, when the postoperative MELD was also calculated.
  
  
  RESULTS
  The aminotransferases reached a maximum increase 24 hours after surgery in both the S and NS groups. There was a significantly higher increase in BE and blood lactate in the NS group, especially after 5 minutes of afterial reperfusion of the graft, p<0.05. There was no significant difference in preoperative MELD between groups (p>0.05), while the postoperative MELD was higher in the NS than in the S group (p<0.05)
  
  
  CONCLUSIONS
  Joint analysis of postoperative MELD, BE and blood lactate can be used as an index of severity of the postoperative course of patients submitted to liver transplantation.
authors: Digestive Surgery Division, Department of Surgery and Anatomy, Faculty of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil.
authors: Nathalia
authors: N
authors: Cardoso
authors: Tiago
authors: T
authors: Silva
authors: Daniel
authors: D
authors: Cagnolati
authors: Thiago
authors: T
authors: Freitas
authors: Enio David
authors: ED
authors: Mente
authors: Anibal
authors: A
authors: Basile-Filho
authors: Orlando
authors: O
authors: Castro e Silva
mesh_terms: D000328:Adult; D000410:Alanine Transaminase / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D058625:End Stage Liver Disease / Q000401:mortality / Q000601:surgery*; D005260:Female; D006801:Humans; D007511:Ischemia; D019344:Lactic Acid / Q000097:blood*; D016031:Liver Transplantation / Q000401:mortality* / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D011379:Prognosis; D012372:ROC Curve; D012720:Severity of Illness Index; D015996:Survival Rate
chemical_list: D015415:Biomarkers; D019344:Lactic Acid; D000410:Alanine Transaminase