The interrelation between arterial lactate levels and postoperative outcome following liver transplantation.

BACKGROUND

The aim of this study was to determine whether arterial blood lactate concentration at the end of liver transplantation is associated with major postoperative complications, length of Intensive Care Unit (ICU) stay and mortality.

METHODS

Arterial lactate concentration was recorded at the end of surgery in 48 patients (30 males and 18 females) who had underwent liver transplantation (LT) over a six month period between June 2013 and December 2013. Demographic data, laboratory results and postoperative outcome were recorded.

RESULTS

The mean age in the study group was 51.14 years (16-62); all the patients had undergone deceased-donor liver transplantation. The etiology of liver disease was various: viral infections (HBV and HCV), alcoholic cirrhosis, hepatocarcinoma and other rare causes of cirrhosis (Wilson disease) were found. The mean duration of surgery was 407 minutes (240-580). Mean lactate was 2.77 mmol/L (0.8-7.9) and was increased above 1.5 mmol/L in 33 (68.75%) patients. ICU length of stay was longer in patients having lactate levels > 5 mmol/L (p = 0.05). Intraoperative blood loss was higher in patients with lactate > 3 mmol/L (p = 0.012). Major complications including acute kidney injury, need for emergency surgery during ICU stay or primary graft disfunction were observed only in patients with lactate levels > 1.5 mmol/L (18.2%). Sixty days mortality was 100% in the group with lactate > 5 mmol/L (4 patients) compared with 12.5% mortality in patients with lactate level < 5 mmol/L (p = 0.05).

CONCLUSIONS

Arterial lactate concentrations at the end of liver transplantation correlates with increased intraoperative blood loss, longer ICU stay, and increased mortality.