Lactate concentration at the end of liver transplant: Early predictor of graft function or just one piece of the puzzle?

Author:

Galli Alessandro M.12ORCID,Kothari Rishi1ORCID,Adelmann Dieter1ORCID,Holm Zacharias13ORCID,Bokoch Michael P.1ORCID,De Gasperi Andrea4ORCID,Niemann Claus U.15ORCID,Kolodzie Kerstin167ORCID

Affiliation:

1. Department of Anesthesia and Perioperative Care University of California San Francisco San Francisco California USA

2. Department of Critical Care Medicine and Anesthesia ASST Papa Giovanni XXIII Bergamo Italy

3. University of Copenhagen Copenhagen Denmark

4. Division of Transplant Surgery Department of Surgery ASST Grande Ospedale Metropolitano Niguarda Milan Italy

5. Division of Transplant Surgery, Department of Surgery University of California San Francisco San Francisco California USA

6. Department of Epidemiology & Biostatistics University of California San Francisco San Francisco California USA

7. Philip R. Lee Institute for Health Policy Studies University of California San Francisco San Francisco California USA

Abstract

AbstractBackgroundThe post‐operative course after Liver Transplantation (LT) can be complicated by early allograft dysfunction (EAD), primary nonfunction (PNF) and death. A lactate concentration at the end of transplant of ≥5 mmol/L was recently proposed as a predictive marker of PNF, EAD, and mortality; this study aimed to validate these previous reports in a large single center cohort.MethodsThis retrospective cohort study included adult liver transplant recipients who received grafts from deceased donors at our center between June 2012 and May 2021. Receiver operating characteristic (ROC) curves for the lactate concentration at the end of transplantation were computed to determine the AUC for PNF, EAD and mortality at 90 days.ResultsIn our cohort of 1137 cases, the AUCs for lactate to predict EAD, PNF and mortality were respectively .56 (95% confidence interval [CI]: .53–.60), .69 (95% CI: .52–.85), and .74 (95% CI: .63–.84).ConclusionThe clinical value of lactate concentration at the end of transplantation to predict PNF, EAD and mortality at 90 days was, at best, modest, as shown by the relatively low AUCs. Our findings cannot validate previous reports that the lactate level alone is a good predictor of poor outcomes after liver transplantation.

Publisher

Wiley

Subject

Transplantation

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