Telephone: +47-23070000; FAX: +47-23073684;
Early bedside detection of ischemia and rejection in liver transplants by microdialysis†
Article first published online: 12 JUL 2012
Copyright © 2012 American Association for the Study of Liver Diseases
Volume 18, Issue 7, pages 839–849, July 2012
How to Cite
Haugaa, H., Thorgersen, E. B., Pharo, A., Boberg, K. M., Foss, A., Line, P. D., Sanengen, T., Almaas, R., Grindheim, G., Pischke, S. E., Mollnes, T. E. and Tønnessen, T. I. (2012), Early bedside detection of ischemia and rejection in liver transplants by microdialysis. Liver Transpl, 18: 839–849. doi: 10.1002/lt.23425
The study was financially supported by grants 2009007 and 2008104 from the South-Eastern Norwegian Health Authority.
- Issue published online: 12 JUL 2012
- Article first published online: 12 JUL 2012
- Accepted manuscript online: 12 MAR 2012 05:52AM EST
- Manuscript Accepted: 29 FEB 2012
- Manuscript Received: 9 DEC 2011
This study was performed to explore whether lactate, pyruvate, glucose, and glycerol levels sampled via microdialysis catheters in the transplanted liver could be used to detect ischemia and/or rejection. The metabolites were measured at the bedside every 1 to 2 hours after the operation for a median of 10 days. Twelve grafts with biopsy-proven rejection and 9 grafts with ischemia were compared to a reference group of 39 grafts with uneventful courses. The median lactate level was significantly higher in both the ischemia group [5.8 mM (interquartile range = 4.0-11.1 mM)] and the rejection group [2.1 mM (interquartile range = 1.9-2.4 mM)] versus the reference group [1.5 mM (interquartile range = 1.1-1.9 mM), P < 0.001 for both]. The median pyruvate level was significantly increased only in the rejection group [185 μM (interquartile range = 155-206 μM)] versus the reference group [124 μM (interquartile range = 102-150 μM), P < 0.001], whereas the median lactate/pyruvate ratio and the median glycerol level were increased only in the ischemia group [66.1 (interquartile range = 23.9-156.7) and 138 μM (interquartile range = 26-260 μM)] versus the reference group [11.8 (interquartile range = 10.6-13.6), P < 0.001, and 9 μM (interquartile range = 9-24 μM), P = 0.002]. Ischemia was detected with 100% sensitivity and greater than 90% specificity when a positive test was repeated after 1 hour. In 3 cases of hepatic artery thrombosis, ischemia was detected despite normal blood lactate levels. Consecutive pathological measurements for 6 hours were used to diagnose rejection with greater than 80% sensitivity and specificity at a median of 4 days before the activity of alanine aminotransferase, the concentration of bilirubin in serum, or both increased. In conclusion, bedside measurements of intrahepatic lactate and pyruvate levels were used to detect ischemia and rejection earlier than current standard methods could. Discrimination from an uneventful patient course was achieved. Consequently, intrahepatic graft monitoring with microdialysis may lead to the earlier initiation of graft-saving treatment. Liver Transpl, 2012. © 2012 AASLD.