Arterial Lactate Concentration at the End of Liver Transplantation Is an Early Predictor of Primary Graft Dysfunction.

Abstract

BACKGROUND:

Although many prognostic factors of primary graft dysfunction after liver transplantation (LT) are available, it remains difficult to predict failure in a given recipient.

OBJECTIVE:

We aimed to determine whether the intraoperative assay of arterial lactate concentration at the end of LT (LCEOT) might constitute a reliable biological test to predict early outcomes [primary nonfunction (PNF), early graft dysfunction (EAD)].

METHODS:

We reviewed data from a prospective database in a single center concerning patients transplanted between January 2015 and December 2016 (n = 296).

RESULTS:

There was no statistical imbalance between the training (year 2015) and validation groups (year 2016) for epidemiological and perioperative feature. Ten patients (3.4%) presented with PNF, and EAD occurred in 62 patients (20.9%); 9 patients died before postoperative day (POD) 90. LCEOT ≥5 mmol/L was the best cut-off point to predict PNF (Se=83.3%, SP=74.3%, positive likelihood ratio (LR+)=3.65, negative likelihood ratio (LR-)=0.25, diagnostic odds ratio (DOR)=14.44) and was predictive of PNF (P = 0.02), EAD (P = 0.05), and death ≤ POD90 (P = 0.06). Added to the validated BAR-score, LCEOT improved its predictive value regarding POD 90 survival with a better AUC (0.87) than BAR score (0.74). The predictive value of LCEOT was confirmed in the validation cohort.

CONCLUSION:

As a reflection of both hypoperfusion and tissue damage, the assay of arterial LCEOT ≥5 mmol/L appears to be a strong predictor of early graft outcomes and may be used as an endpoint in studies assessing the impact of perioperative management. Its accessibility and low cost could impose it as a reliable parameter to anticipate postoperative management and help clinicians for decision-making in the first PODs.

• Authors: Nicolas Golse, Nicola Guglielmo, Albert El Metni, Fabio Frosio, Cyril Cosse, Salima Naili, Philippe Ichaï, Oriana Ciacio, Gabriella Pittau, Marc-Antoine Allard, Denis Castaing, Antonio S A Cunha, Daniel Cherqui, René Adam, Eric Vibert
• Journal: Annals of surgery (Ann Surg) Vol. 270 Issue 1 Pg. 131-138 (07 2019) ISSN: 1528-1140 [Electronic] United States
• PMID: 29509585 (Publication Type: Journal Article, Observational Study)

Chemical References

• Biomarkers
• Lactic Acid

Topics

• Adult
• Aged
• Aged, 80 and over
• Area Under Curve
• Biomarkers (blood)
• Clinical Decision Rules
• Female
• Graft Survival
• Humans
• Intraoperative Care (methods)
• Lactic Acid (blood)
• Liver Transplantation
• Male
• Middle Aged
• Predictive Value of Tests
• Primary Graft Dysfunction (blood, diagnosis)
• Prognosis
• Reproducibility of Results
• Retrospective Studies