Interstitial Glucose Metabolism Monitoring as an Additional Method for Objective Assessment of Donor Liver, Prediction and Immediate Diagnosis of Early Graft Dysfunction.

Abstract

The current clinical practice of assessing the quality and suitability of a donor liver for human transplantation does not exclude cases of primary graft dysfunction of the transplanted organ and, at the same time, leads to an unreasonable refusal to transplant a significant number of functionally suitable organs. In this regard, searching for new methods for additional objective assessment and monitoring of the state of donor organs in the peritransplant period is relevant. The aim of the study was to determine the clinical utility of monitoring interstitial concentrations of glucose and its metabolites to assess the viability and functional state of a donor liver before and after human transplantation.

Materials and methods: A retrospective observational single-center study included 32 cases of liver transplantation. Along with standard methods for assessing the initial function of grafts during the first week after surgery, interstitial (in the transplanted liver) concentrations of glucose and its metabolites were monitored. In 18 cases, the interstitial glucose metabolism was also studied during static cold storage (SCS).

Results: With the development of early allograft dysfunction (EAD), compared with the uneventful post-transplant period, statistically significantly higher interstitial lactate concentrations were observed as early as 3 h after reperfusion: 12.3 [10.1; 15.6] mmol/L versus 7.2 [3.9; 9.9] mmol/L (p=0.003). A value above 8.8 mmol/L may be considered as a criterion for the immediate diagnosis of EAD (sensitivity - 89%, specificity - 65%).Interstitial lactate concentration at the end of SCS and the area under the "lactate concentration-SCS duration" curve were associated with the initial graft function. Values of these parameters greater than 15.4 mmol/L and 76.1 mmol/L·h, respectively, with a sensitivity of 100% in both cases and a specificity of 77 and 85%, may be used to assess the risk of primary EAD.

Conclusion: Monitoring of interstitial concentrations of glucose and its metabolites, primarily, lactate, is an objective additional method for the assessment of the donor liver viability both during SCS and in the early postoperative period.