Predictive value of early postoperative lactate (<6 h) during normothermic machine perfusion and outcome after liver transplantation: results from a multicentre study.
Author
Hofmann, JuliaMeszaros, Andras T
Butler, Andrew
Hann, Angus
Hartog, Hermien
Kneifel, Felicia
Iype, Satheesh
Crick, Keziah
Cardini, Benno
Fiore, Barbara
Attia, Magdy
Pollok, Joerg-Matthias
Pascher, Andreas
Vogel, Thomas
Perera, Thamara
Watson, Christopher J E
Schneeberger, Stefan
Publication date
2024-06-12Subject
Gastroenterology
Metadata
Show full item recordAbstract
Background: Biomarkers with strong predictive capacity towards transplantation outcome for livers undergoing normothermic machine perfusion (NMP) are needed. We investigated lactate clearing capacity as a basic function of liver viability during the first 6 h of NMP. Methods: A trial conducted in 6 high-volume transplant centres in Europe. All centres applied a back-to-base NMP approach with the OrganOx metra system. Perfusate lactate levels at start, 1, 2, 4 and 6 h of NMP were assessed individually and as area under the curve (AUC) and correlated with EAD (early allograft dysfunction), MEAF (model for early allograft function) and modified L-GrAFT (liver graft assessment following transplantation) scores. Results: A total of 509 livers underwent ≥6 h of NMP before transplantation in 6 centres in the UK, Germany and Austria. The donor age was 53 (40-63) years (median, i.q.r.).The total NMP time was 10.8 (7.9-15.7) h. EAD occurred in 26%, MEAF was 4.72 (3.54-6.05) and L-GrAFT10 -0.96 (-1.52--0.32). Lactate at 1, 2 and 6 h correlated with increasing robustness with MEAF. Rather than a binary assessment with a cut-off value at 2 h, the actual 2 h lactate level correlated with the MEAF (P = 0.0306 versus P = 0.0002, Pearson r = 0.01087 versus r = 0.1734). The absolute lactate concentration at 6 h, the AUC of 0-6 h and 1-6 h (P < 0.0001, r = 0.3176) were the strongest predictors of MEAF. Conclusion: Lactate measured 1-6 h and lactate levels at 6 h correlate strongly with risk of liver allograft dysfunction upon transplantation. The robustness of predicting MEAF by lactate increases with perfusion duration. Monitoring lactate levels should be extended to at least 6 h of NMP routinely to improve clinical outcome.Citation
Hofmann J, Meszaros AT, Butler A, Hann A, Hartog H, Kneifel F, Iype S, Crick K, Cardini B, Fiore B, Attia M, Pollok JM, Pascher A, Vogel T, Perera T, Watson CJE, Schneeberger S. Predictive value of early postoperative lactate (<6 h) during normothermic machine perfusion and outcome after liver transplantation: results from a multicentre study. Br J Surg. 2024 Jun 12;111(6):znae084. doi: 10.1093/bjs/znae084. Erratum in: Br J Surg. 2024 Jul 2;111(7):znae182. doi: 10.1093/bjs/znae182.Type
ArticleOther
Additional Links
http://onlinelibrary.wiley.com/journal/10.1002/(ISSN)1365-2168PMID
38875136Journal
The British Journal of SurgeryPublisher
Oxford University Pressae974a485f413a2113503eed53cd6c53
10.1093/bjs/znae084