Division of Transplant and Hepatobiliary Surgery, Henry Ford Hospital, Detroit, Michigan.
Department of Surgery, University of Tsukuba, Tsukuba, Japan.
Clin Transplant. 2019 Jul;33(7):e13613. doi: 10.1111/ctr.13613. Epub 2019 Jun 20.
This study aimed to investigate risk factors for early allograft dysfunction (EAD) and outcomes after liver transplantation (LT), focusing on peri-transplant lactate clearance. We reviewed patients who underwent deceased donor LTs between 2011 and 2014. Lactate levels were checked at reperfusion and at the time of intensive care unit admission. Early lactate clearance was defined as reduction rate of lactate between the times of reperfusion and immediately after LT. Patients were categorized into the normal and delayed clearance groups. We used propensity score matching (PSM) between these two groups to estimate an impact of lactate clearance on incidence of EAD and graft survival. A total of 256 recipients were eligible for this study. Cut-off value of lactate clearance to predict occurrence of EAD was determined at 0.2 mmol/L/h. After PSM, 120 patients in the normal clearance and 36 patients in the delayed clearance group were matched. Delayed lactate clearance was considered as an independent risk factor for EAD (Odds ratio 3.49, P = 0.002). The adjusted hazard of one-year graft loss was significantly increased in the delayed clearance group (hazard ratio 6.69, P = 0.001). In conclusion, peri-transplant delayed lactate clearance may be a strong predictor for EAD and poor liver graft outcomes.
本研究旨在探讨肝移植（LT）后早期移植物功能障碍（EAD）的风险因素和结局，重点关注移植前乳酸清除率。我们回顾了 2011 年至 2014 年期间接受过已故供体 LT 的患者。在再灌注时和入住重症监护病房时检查乳酸水平。早期乳酸清除定义为再灌注和 LT 后即刻之间的乳酸减少率。患者分为正常清除组和延迟清除组。我们使用这两组之间的倾向评分匹配（PSM）来估计乳酸清除对 EAD 发生率和移植物存活率的影响。共有 256 名受者符合本研究条件。乳酸清除预测 EAD 发生的截断值为 0.2mmol/L/h。PSM 后，正常清除组有 120 例患者，延迟清除组有 36 例患者。延迟乳酸清除被认为是 EAD 的独立危险因素（比值比 3.49，P=0.002）。延迟清除组一年移植物丢失的调整风险显著增加（风险比 6.69，P=0.001）。总之，移植前延迟乳酸清除可能是 EAD 和不良肝移植物结局的强预测因子。
