HIGHER INTRA-OPERATIVE PEAK LACTATE VALUE MAY BE ASSOCIATED WITH PROLONGED HEMODIALYSIS REQUIREMENT AFTER LIVER TRANSPLANT ALONE IN PATIENTS WITH PRE- TRANSPLANT KIDNEY DYSFUNCTION

Authors

Katsunori Miyake, Henry Ford HealthFollow
Saleh Al-Juburi, Henry Ford HealthFollow
Kelly Z. Young, Henry Ford HealthFollow
Lucy Chau, Henry Ford HealthFollow
Toshihiro Kitajima, Henry Ford HealthFollow
Niluka Wickramaratne, Henry Ford HealthFollow
Ahmed Nassar, Henry Ford HealthFollow
Atsushi Yoshida, Henry Ford HealthFollow
Dilip Moonka, Henry Ford HealthFollow
Deepak Venkat, Henry Ford HealthFollow
Marwan S. Abouljoud, Henry Ford HealthFollow
Shunji Nagai, Henry Ford HealthFollow

Recommended Citation

Miyake K, Al-Juburi S, Young K, Chau LC, Kitajima T, Wickramaratne N, Nassar A, Yoshida A, Moonka D, Venkat D, Abouljoud MS, and Nagai S. HIGHER INTRA-OPERATIVE PEAK LACTATE VALUE MAY BE ASSOCIATED WITH PROLONGED HEMODIALYSIS REQUIREMENT AFTER LIVER TRANSPLANT ALONE IN PATIENTS WITH PRE- TRANSPLANT KIDNEY DYSFUNCTION. Hepatology 2023; 78:S314-S315.

Document Type

Conference Proceeding

Publication Date

11-2023

Publication Title

Hepatology

Abstract

Background: Liver transplant alone (LTA) patients with kidney dysfunction might require intraoperative CVVH which potentially leads to prolonged posttransplant hemodialysis requirement. While pre-transplant kidney function is a well-known factor associated with the likelihood of kidney function recovery after transplant, possible association with intraoperative factors was not well studied. Intra-operative lactate could be a good surrogate marker reflecting the surgical stress such as significant blood loss, prolonged ischemia time, and marginal liver graft function. This study aimed to investigate a possible association between intra-operative peak lactate value and prolonged post-LTA hemodialysis requirement.

Methods: Medical charts of all liver transplant patients from August 2017 to December 2022 were retrospectively reviewed. LTA patients who required intraoperative CVVH due to kidney dysfunction were eligible for this study. The association between the intra-operative peak lactate value and the requirement of hemodialysis over 30 days post-LTA was evaluated. The median intra-operative peak lactate value of the patient population (4.5mmol/L) was used as a cut-off value to dichotomize patients (low lactate group: 4.5mmol/L < , high lactate group: > = 4.5mmol/L).

Results: Among 548 liver transplant recipients during the study period, 433 underwent LTA, of whom 46 required intraoperative CVVH. Of these 46, 7 had a history of diabetes (15.2%) and 7 required hemodialysis before transplant (15.2%). After LTA, 11 required hemodialysis over 30 days (23.9%) (prolonged post-LTA hemodialysis requirement). In univariable logistic regression analysis, the risk of prolonged post-LTA hemodialysis was significantly higher in the high lactate group, compared to the low lactate group (OR: 5.34, 95%Cl: 1.01-28.4, p = 0.049). History of diabetes and requirement of hemodialysis before LTA was also associated with prolonged hemodialysis requirement after LTA (OR: 6.10, 95% Cl: 1.11-33.6, p = 0.038 and OR: 6.10, 95%Cl: 1.11- 33.6, p = 0.038, respectively). In multivariable analysis, the high lactate group was considered to be an independent risk factor for prolonged post-LTA HD (OR: 13.8, 95%Cl: 1.28-148.0, p = 0.031).

Conclusion: Higher intra-operative peak lactate value significantly increases the risk of hemodialysis requirement over 30 days post-LTA. Intraoperative surgical stress may affect kidney function recovery and lactate values can be a good predictive marker.

Volume

78

First Page

S314

Last Page

S315