Head of the Laboratory of Advanced Surgical Technologies; Burnasyan Federal Medical Biophysical Center of FMBA of Russia, 23 Marshal Novikov St., Moscow, 123098, Russia.
Professor, Corresponding Member of the Russian Academy of Sciences, Deputy Chief Physician for Surgical Care - Head of the Center for Surgery and Transplantology; Burnasyan Federal Medical Biophysical Center of FMBA of Russia, 23 Marshal Novikov St., Moscow, 123098, Russia.
Sovrem Tekhnologii Med. 2022;14(3):28-39. doi: 10.17691/stm2022.14.3.04. Epub 2022 May 28.
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. 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.
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).
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.
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.
本研究旨在确定监测葡萄糖及其代谢物间质浓度在人体肝移植前后评估供体肝活力和功能状态的临床实用性。
回顾性观察性单中心研究纳入 32 例肝移植患者。除了在手术后第一周评估移植物初始功能的标准方法外，还监测了间质（移植肝内）葡萄糖及其代谢物的浓度。在 18 例中，还研究了间质葡萄糖代谢在静态冷保存（SCS）期间的情况。
与无事件的移植后期间相比，随着早期移植物功能障碍（EAD）的发展，早在再灌注后 3 小时就观察到间质乳酸浓度显著升高：12.3 [10.1; 15.6] mmol/L 比 7.2 [3.9; 9.9] mmol/L（p=0.003）。高于 8.8 mmol/L 的值可被视为 EAD 即时诊断的标准（敏感性为 89%，特异性为 65%）。SCS 结束时的间质乳酸浓度和“乳酸浓度-SCS 持续时间”曲线下面积与初始移植物功能相关。这些参数的值分别大于 15.4 mmol/L 和 76.1 mmol/L·h，在两种情况下的敏感性均为 100%，特异性分别为 77%和 85%，可用于评估原发性 EAD 的风险。
监测葡萄糖及其代谢物，主要是乳酸的间质浓度，是在 SCS 期间和术后早期评估供体肝活力的客观附加方法。
