Estimation of blood lactate levels during living related liver transplantation: Correlation with various clinical factors

Abstract

Background: Peri-operative changes in blood lactate concentration could be used as an indicator of graft viability and of the quality of functional recovery of the graft in living related liver transplantation (LRLT). Peri-operative blood lactate profiles were measured to evaluate which factors determine lactate elevation before reperfusion, as well as those that determine graft function after reperfusion in recipients undergoing LRLT. Methods: twenty adult patients were included in this study. We measured blood lactate, plasma bilirubin, aminotransefrase, and core body temperature at six points during surgery. The rate of lactate accumulation during the pre-anhepatic and anhepatic phases and the elimination rate during the neohepatic phase were calculated. The correlation between these results and the clinical findings was examined. Results: blood lactate rose significantly from the base line till it reached a maximum at T3 (the point at witch the neohepatic phase starts) then decreased significantly till the end of the study. Liver enzymes (AST and ALT) rose consistently throughout the study period. Serum bilirubin declined significantly throughout the study period. Core temperature decreased significantly from the start of the study to a minimum at T3, and then started to rise again. Lactate accumulation in the pre-anhepatic phase was significantly correlated with preoperative bilirubin. Lactate elimination in the neohepatic phase significantly correlated with graft weight. Conclusion: blood lactate levels continue to increase until the graft liver is reperfused, and usually begin to decrease after reperfusion. Both preoperative plasma bilirubin level and graft weight affected lactate accumulation during pre-anhepatic phase and lactate elimination during neohepatic phase respectively.