Lactate level immediate post-liver transplantation is a predictor of early allograft dysfunction.
Takahashi K, Nagai S, Safwan M, Putchakayala K, Collins K, Rizzari M, Yoshida A, Abouljoud M, and Jafri SM. Lactate level immediate post-liver transplantation is a predictor of early allograft dysfunction. Am J Transplant 2017; 17:581.
Am J Transplant
Background; Early allograft dysfunction (EAD) after liver transplantation (LT) is defined as a peak values of aminotransferase >2000 IU/mL during the first week or an international normalized ratio ≥1.6 and/or bilirubin ≥10 mg/dL at day 7. While lactate level is a well-known parameter of liver graft function, an association with EAD has not been established. This study aimed to investigate early predictors for EAD, focusing on serum lactate. Method; We retrospectively reviewed 265 deceased donor LT's between 2011 and 2014. Recipient, donor, and operative factors were analyzed as possible risk factors for EAD by logistic regression model. Results; EAD occurred in 56 cases (21.8%). Perioperative lactate trends showed peak lactate immediately after reperfusion with a nadir between 6-48 hours after transplant (Figur presented). A cut-off value for lactate level immediately post-LT predicting EAD was 3.45 mmol/L (area under curve 0.70). On multivariate analysis the following were independent risk factors for EAD: macrosteatosis>20% (Odds ratio [OR]=3.35, P=0.03), reoperation within 7 days (OR=1.10, P=0.003), and lactate level >3.45 mmol/L immediately post-LT (OR=3.18, P=0.002). Warm ischemia time (WIT) exceeding 45 minutes was associated with elevated lactate immediately post-LT (OR =3.26, P =0.002).[table1]Conclusions; High lactate level immediately post-LT is a predictor of EAD. Minimizing WIT may further decrease the risk of EAD.