Combination of arterial lactate levels and Cv‐aCO2/Da‐vO2 ratio to predict early allograft dysfunction after liver transplantation

Abstract

Purpose We examined the ability of the P(v‐a)CO2/Da‐vO2 ratio combined with elevated lactate levels to predict early allograft dysfunction (EAD). Materials and methods Patients were classified into four groups according to lactate levels and P(v‐a)CO2/Da‐vO2 ratio: Group 1; lactate >2.0 mmol/L and P(v‐a)CO2/Da‐vO2 ratio >1.0; Group 2; lactate >2.0 mmol/L and P(v‐a)CO2/Da‐vO2 ratio <1.0; group 3; lactate<2.0 mmol/L and P(v‐a)CO2/Da‐vO2 ratio >1.0; group 4; lactate<2.0 mmol/L and P(v‐a)CO2/Da‐vO2 ratio <1.0. We defined EAD according to Olthoff criteria. Results One‐hundred and fifty patients were included. EAD occurred in 41 patients (27.3%), and was associated with worse graft survival at 1 year (92% vs. 73%; P = ,003) as well as a higher re‐transplantation rate (4,6% vs. 17,1%; P = ,019). The multivariate analysis revealed that P(v‐a)CO2/Da‐vO2 ratio at T6 [OR 7.05(CI95% 2.77–19.01, P<.001)] was an independent predictor for EAD. Belonging to group 1 at 6 h was associated with worse clinical outcomes but no association was found with 1‐year graft survival or 1‐year patient survival. Conclusions In this single center, prospective, observational study in patients who received an OLT, we found that elevated lactate levels combined with a high Cv‐aCO2/Da‐vO2 after 6 h was associated with the development of EAD and worse clinical outcomes in the early postoperative period.

Biomarkers and predictive models of early allograft dysfunction in liver transplantation – A systematic review of the literature, meta‐analysis, and expert panel recommendations

“…In addition, a scoring system that combines the potential biomarkers will provide a better prediction model for EAD. 19,25 Recipients with EAD have a higher probability of graft loss (failure), longer intensive care unit (ICU), and hospital stays than recipients without EAD. 4 The most acceptable EAD definition in Model for Endstage Liver Disease (MELD) era was developed by Olthoff in 2010, 2 but it is a developing field.…”

“…Elevated arterial and intragraft lactate level was recommended as a precise early biomarker for predicting EAD after adult liver transplantation. The recommendation was based on the critical meta‐analysis from three independent studies, and the pooled DOR was as high as 7.15, with the sensitivity ranging from .39 to .86 and the specificity ranging from .69 to 0.83 16,18,19 . The QOE of recommendation for using arterial and intragraft lactate was moderate and the strength for recommendation was strong.…”

“…Further studies with multi‐cohorts using well‐designed protocols will be essential for developing new inflammatory, metabolic, or even molecular biomarkers. In addition, a scoring system that combines the potential biomarkers will provide a better prediction model for EAD 19,25 …”

“…Lactate levels from arterial blood or biopsy applied in three studies containing total 298 participants were performed metaanalysis. 16,18,19 The SROC illustrated the relatively low predictive value with diverse sensitivity and specificity among the 3 studies (Figure 3). The sensitivity varied between 39% and 86%, whereas How substantial are the desirable anticipated effects?…”

“…After this initial quality control evaluation steps, only 10 studies were finally included for the systemic review. [16][17][18][19][20][21][22][23][24][25] A flow chart of study selection process is shown in Figure 1. The selection process was conducted by two researchers in an independent manner.…”