Serum Lactate Clearance as a Predictive Biomarker for Optimal Graft Perfusion in Living Donor Liver Transplantation

IF 2.5 2区医学 Q1 PEDIATRICS Journal of pediatric surgery Pub Date : 2025-02-01 DOI:10.1016/j.jpedsurg.2024.07.032

Keisuke Kajihara, Toshiharu Matsuura, Yasuyuki Uchida, Maeda Shohei, Yukihiro Toriigahara, Yoshiaki Takahashi, Tatsuro Tajiri

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Abstract

Background

The optimal balance between the graft volume (GV) and portal venous flow (PVF) in living donor liver transplantation (LDLT) is unclear. As lactate is mainly metabolized in the liver, perioperative lactate levels are reportedly a useful biomarker for early graft dysfunction (EGD). The present study analyzed perioperative lactate levels according to the PVF.

Methods

The PVF/GV (mL/min per 100 g GV) of 97 recipients from 1996 to 2022 was retrospectively classified as low (LPVF; PVF/GV ≤ 100, N = 29), moderate (MPVF; PVF/GV 100–250, N = 40), or high (HPVF; PVF/GV > 250, N = 28). Lactate levels were obtained preoperatively (L0), immediately after graft reperfusion (L1), 4 h after reperfusion (L2), and on postoperative day 3 (L3). The lactate clearances were then calculated.

Results

The lower the PVF/GV ratio, the younger the age at LDLT and the higher the graft-to-recipient weight ratio. The median L2 and L3 in the HPVF group were significantly higher than those in the other groups (p = 0.019 and p = 0.003, respectively). The median ΔL1 in the HPVF group was lower than that in the LPVF and MPVF groups (0.23 vs. 0.50, p < 0.0001 and 0.23 vs. 0.41, p = 0.011, respectively). ΔL1 was negatively correlated with the PVF/GV. Although no patient had EGD, three patients with HPVF with low ΔL1 developed small-for-size syndrome.

Conclusions

Graft hyperperfusion may delay the recovery of the graft function and result in poor lactate clearance. The combination of the PVF/GV and lactate clearance may be useful as a prognostic marker for optimal graft perfusion in LDLT.

Level of evidence

IV.

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血清乳酸清除率作为活体肝移植最佳移植物灌注的预测性生物标志物

背景活体肝移植（LDLT）中移植物体积（GV）和门静脉流量（PVF）之间的最佳平衡尚不清楚。由于乳酸主要在肝脏代谢，围手术期乳酸水平是早期移植物功能障碍（EGD）的有用生物标志物。本研究根据PVF分析围术期乳酸水平。方法回顾性分析1996 ~ 2022年97例受者的PVF/GV （mL/min / 100g GV）为低(LPVF；PVF/GV≤100,N = 29)，中等(MPVF；PVF/GV 100-250, N = 40)，或高(HPVF；聚氟乙烯/问比;250, n = 28)。测定术前（L0）、移植物再灌注后立即（L1）、再灌注后4小时（L2）和术后第3天（L3）的乳酸水平。然后计算乳酸清除率。结果PVF/GV比值越低，LDLT患者年龄越小，移植物/受体重量比越高。HPVF组中位L2和L3明显高于其他组（p = 0.019和p = 0.003）。HPVF组中位ΔL1低于LPVF组和MPVF组(0.23 vs. 0.50, p <；0.0001和0.23 vs. 0.41, p = 0.011)。ΔL1与PVF/GV呈负相关。虽然没有患者发生EGD，但有3例低ΔL1的HPVF患者发生了小尺寸综合征。结论移植物高灌注可延缓移植物功能的恢复，导致移植物乳酸清除率降低。PVF/GV和乳酸清除率的结合可作为LDLT移植血管最佳灌注的预后指标。证据水平：

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来源期刊

Journal of pediatric surgery 医学-外科

CiteScore

1.10

自引率

12.50%

发文量

569

审稿时长

38 days

期刊介绍： The journal presents original contributions as well as a complete international abstracts section and other special departments to provide the most current source of information and references in pediatric surgery. The journal is based on the need to improve the surgical care of infants and children, not only through advances in physiology, pathology and surgical techniques, but also by attention to the unique emotional and physical needs of the young patient.