title: Prediction of poor graft function by means of gastric tonometry in patients undergoing liver transplantation.
abstract: INTRODUCTION. Splanchnic hypoperfusion appears to play a key role in the failure of functional recovery of the graft after orthotopic liver transplantation (LT). The aim of this study was to determine if alterations of tonometric parameters, which are related to splanchnic perfusion, could predict poor graft function in patients undergoing LT.
  
  
  METHODS
  After Ethics Committee approval, 68 patients undergoing LT were enrolled. In all the patients, regional-arterial CO2 gradient (Pr-aCO2) was recorded; in addition, the difference between Pr-aCO2 recorded at anhepatic phase (T1) and at the end of surgery (T2) (T2- T1 = ΔPr-aCO2) was calculated. Poor graft function was determined on the basis of Toronto's classification 72 hours after LT. Student t-test and logistic regression analysis were used for statistical purpose. Results. ΔPr-aCO2 was significantly greater in patients with poor graft function (3.5 ± 13.2) compared to patients with good graft function (-5.8 ± 12.3) (p = 0.014). The logistic regression analysis showed that the ΔPr-aCO2 was able to predict the onset of poor graft function (p = 0.037). A value of ΔPr-aCO2 ≥ -4 was associated with poor graft function with a sensibility of 93.3% and a specificity of 42.3%. CONCLUSION. Our study suggests that the change of Pr-aCO2 may be a valuable index of graft dysfunction. Gastric tonometry might give early prognostic information on the graft outcome, and it may aid clinicians in planning a more strict follow-up and proper interventions in order to improve graft survival.
authors.affiliation: Department of Anesthesiology and Intensive Care, "A. Gemelli" Hospital. Rome, Italy.
authors.forename: Valter
authors.initials: V
authors.lastname: Perilli
authors.affiliation: Department of Anesthesiology and Intensive Care, "A. Gemelli" Hospital. Rome, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Aceto
authors.affiliation: Department of Anesthesiology and Intensive Care, "A. Gemelli" Hospital. Rome, Italy.
authors.forename: Cristina
authors.initials: C
authors.lastname: Modesti
authors.affiliation: Department of Anesthesiology and Intensive Care, "A. Gemelli" Hospital. Rome, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Vitale
authors.affiliation: Department of Anesthesiology and Intensive Care, "A. Gemelli" Hospital. Rome, Italy.
authors.forename: Pierpaolo
authors.initials: P
authors.lastname: Ciocchetti
authors.affiliation: Department of Anesthesiology and Intensive Care, "A. Gemelli" Hospital. Rome, Italy.
authors.forename: Teresa
authors.initials: T
authors.lastname: Sacco
authors.affiliation: Department of Anesthesiology and Intensive Care, "A. Gemelli" Hospital. Rome, Italy.
authors.forename: Alessia
authors.initials: A
authors.lastname: Adduci
authors.affiliation: Dynamic and Clinical Psychology Department, Sapienza University of Rome, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Lai
authors.affiliation: Department of Surgery, Transplantation Service, "A. Gemelli" Hospital, Italy.
authors.forename: Alfonso W
authors.initials: AW
authors.lastname: Avolio
authors.affiliation: Department of Anesthesiology and Intensive Care, "A. Gemelli" Hospital. Rome, Italy.
authors.forename: Liliana
authors.initials: L
authors.lastname: Sollazzi
mesh_terms: D000328:Adult; D002245:Carbon Dioxide / Q000378:metabolism*; D005260:Female; D005753:Gastric Mucosa / Q000098:blood supply / Q000378:metabolism*; D006085:Graft Survival; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008099:Liver / Q000098:blood supply*; D008103:Liver Cirrhosis / Q000601:surgery*; D016031:Liver Transplantation; D016015:Logistic Models; D008297:Male; D008365:Manometry; D008875:Middle Aged; D011379:Prognosis; D013152:Splanchnic Circulation / Q000502:physiology; D019737:Transplants / Q000098:blood supply*; D016896:Treatment Outcome
chemical_list: D002245:Carbon Dioxide