Comparative study between the effects of intraoperative sodium bicarbonate infusion versus Ringer Acetate on graft outcome after Living Donor Liver Transplantation

Abstract

Orthotopic liver transplantation is considered the definitive management for patients with end stage liver disease. It involves substituting a diseased old liver with a new one, usually a lobe from a living donor. However the operation is complex and difficult in nature. It is characterized by significant electrolyte, acid – base and hemodynamic disturbances that requires a vigilant anesthesia team to detect and correct these imbalances immediately. One of the major unavoidable complications of the operations is lactic acidosis, normally lactic acid -produced by anaerobic metabolism- is cleared by the liver in normal persons. However during OLT patients already suffer from decompensated liver disease and later in the operation complete absence of the liver during the anehepatic phase which result in progressive lactic acid accumulation and consequent lactic acidosis which could negatively affect the graft function. Many techniques have been proposed to treat and ameliorate the deleterious effect of lactic acidosis on the graft. However none was superior over the other lines. In this study 60 patients were randomized in two groups, namely group (NH) which received sodium bicarbonate infusion and group (RA) which received ringer acetate