LACTATE BLOOD-LEVELS IN THE PERIOPERATIVE PERIOD OF ORTHOTOPIC LIVER-TRANSPLANTATION

To investigate whether early postoperative changes in blood lactate co ncentration indicate the functional recovery of the newly grafted live r, changes in oxygen supply, oxygen consumption, acid-base equilibrium , and blood lactate concentrations were prospectively studied in a gro up of 53 postnecrotic cirrhotic patients during the various phases of orthotopic liver transplantation (preanhepatic, anhepatic, neohepatic) and for the first 48 h following reperfusion. The patients were divid ed into two groups according to the quality of the early graft functio n, as indicated by alanine aminotransferase, bile flow, and prothrombi n activity: group A (49 patients), good immediate graft function and g roup B (4 patients), immediate graft non-function. Lactate levels rose in the same manner during the preanhepatic and anhepatic stages and p eaked after revascularization of the graft. Following reperfusion, how ever, distinctly different blood lactate profiles were recorded in the two groups of patients. A fall in lactate concentration was recorded in group A patients, whereas a continuous rise occurred in group B pat ients: the difference becoming significant by the end of surgery (P le ss than or equal to 0.05). During the first 48 h following revasculari zation of the graft, opposite trends in lactate concentration, bile fl ow, alanine aminotransferase, and prothrombin activity were evident in the two groups of patients: 24 h after reperfusion, lactate levels we re below 2 mmol/1 in 47 of 49 patients from group A, while they platea ued above 4 mmol/1 in all patients from group B. Group A patients had lower alanine aminotransferase levels (P less than or equal to 0.001), higher prothrombin activity, (P less than or equal to 0.01), and grea ter bile flow (P less than or equal to 0.02). If validated in larger s eries, the blood lactate profile, probably more than the absolute leve l, appears to be a useful indicator of the early recovery of liver met abolic capacities in the immediate postoperative period of orthotopic liver transplantation.