Early lactate clearance as a reliable predictor of initial poor graft function after orthotopic liver transplantation

摘要

BACKGROUND: Initial poor graft function (IPGF) following orthotopic  liver  transplantation  is  a  major  determinant  of postoperative  survival  and  morbidity.  Lactate  clearance  is  a good marker of liver function. In this study, we investigated the  clinical  utility  of  early  lactate  clearance  as  an  early  and accurate predictor for IPGF following liver transplantation. METHODS: This was a prospective observational study of 222 patients referred to the surgical intensive care unit (SICU) after orthotopic liver transplantation. The IPGF group consisted of patients with alanine aminotransferase (ALT) and/or aspartate aminotransferase  (AST)  >1500  IU/L  within  72  hours  after orthotopic  liver  transplantation.  Early  lactate  clearance  was defined as lactate at SICU presentation (hour 0) minus lactate at hour 6, divided by lactate at SICU presentation. The model for end-stage liver disease (MELD) score, Child-Pugh score and laboratory data including AST, ALT, total bilirubin (TB) and prothrombin  time  (PT)  were  recorded  at  SICU  presentation and  compared  between  the  non-IPGF  and  IPGF  groups. Receiver  operating  characteristic  (ROC)  curves  were  plotted to measure the performance of early lactate clearance, MELD score, Child-Pugh score, TB and PT. RESULTS: IPGF occurred in 45 of the 222 patients (20.3%). The early  lactate  clearance  in  the  non-IPGF  group  was  markedly higher than that in the IPGF group (43.2±13.8% vs 13.4±13.7% P<0.001). The optimum cut-off value for early lactate clearance predicting  IPGF  was  24.8%  (sensitivity  95.5%,  specificity 88.9%). The area under the curve of the ROC was 0.961, which was  significantly  superior  to  MELD  score,  Child-Pugh  score, TB and PT. Patients with early lactate clearance  ≤24.8% had a higher IPGF rate (OR=169) and a higher risk of in-hospital mortality (OR=3.625). CONCLUSIONS: Early lactate clearance can serve as a prompt and  accurate  bedside  predictor  of  IPGF.  Patients  with  early lactate clearance less than 24.8% are associated with a higher incidence of IPGF.