Clinical experience with microdialysis catheters in pediatric liver transplants

Abstract

Ischemic vascular complications and rejection occur more frequently with pediatric liver transplants versus adult liver transplants. Using intrahepatic microdialysis catheters, we measured lactate, pyruvate, glucose, and glycerol values at the bedside for a median of 10 days in 20 pediatric liver grafts. Ischemia (n 5 6), which was defined as a lactate level > 3.0 mM and a lactate/pyruvate ratio > 20, was detected without a measurable time delay with 100% sensitivity and 86% specificity. Rejection (n 5 8), which was defined as a lactate level > 2.0 mM and a lactate/pyruvate ratio < 20 lasting for 6 or more hours, was detected with 88% sensitivity and 45% specificity. With additional clinical criteria, the specificity was 83% without a decrease in the sensitivity. Rejection was detected at a median of 4 days (range 5 1-7 days) before alanine aminotransferase increased (n 5 5, P 5 0.11), at a median of 4 days (range 5 2-9 days) before total bilirubin increased 25% or more (n 5 7, P 5 0.04), and at a median of 6 days (range 5 4-11 days) before biopsy was performed (n 5 8, P 5 0.05). In conclusion, microdialysis catheters can be used to detect episodes of ischemia and rejection before current standard methods in pediatric liver transplants with clinically acceptable levels of sensitivity and specificity. The catheters were well tolerated by the children, and no major complications related to the catheters were observed.

Anaerobic metabolism associated with traumatic hemorrhagic shock monitored by microdialysis of muscle tissue is dependent on the levels of hemoglobin and central venous oxygen saturation: a prospective, observational study

“…Microdialysis is a sufficiently sensitive method for monitoring anaerobic metabolism and it positively correlates with pro-inflammatory markers [28]. This technique can also be used during surgery or transplantation [29]. A slight modification of the method makes it suitable for monitoring the degree of blood perfusion in individual tissues through blood-flow markers, such as ethanol [30] or urea [31-33].…”

Role of microdialysis catheters in clinical decision making: Bench to bedside?

“…These results have been reported in a series of 3 articles published in Liver Transplantation . They have demonstrated that dialysate analysis can distinguish acute rejection from ischemia.…”

“…7,8 Tïnnessen's team from Oslo has developed an increasingly robust data set on the safety, accuracy, and precision of using microdialysis catheters in humans. [9][10][11] The catheters were implanted in the right and left liver lobes just before wound closure, and monitoring of the dialysate proceeded continually for several days after transplantation. The catheters were placed with a split-needle technique to set the introducer, through which the catheter with a diameter of 0.6 mm was passed.…”

“…These results have been reported in a series of 3 articles published in Liver Transplantation. [9][10][11] They have demonstrated that dialysate analysis can distinguish acute rejection from ischemia. Under ischemic conditions, there will be anaerobic metabolism and an increase in lactate levels as well as an increase in the lactate/pyruvate ratio.…”

Lipid peroxidation in multidrug-resistant Gram-negative sepsis: translating science to the septic patient?

“…Questions concerning the underlying mechanism or the hypothesis that a toxic end product may predict survival under certain circumstances cannot be answered from this descriptive study. Microdialysis is an established method to monitor both metabolic and inflammatory markers in clinical settings [12]. Several methods for MDA detection in microdialysis fluid have been described [13] and it would be of great interest to evaluate MDA production directly in different organs throughout the course of sepsis.…”