See Editorial on Page 243
Clinical experience with microdialysis catheters in pediatric liver transplants
Article first published online: 11 MAR 2013
Copyright © 2013 American Association for the Study of Liver Diseases
Volume 19, Issue 3, pages 305–314, March 2013
How to Cite
Haugaa, H., Almaas, R., Thorgersen, E. B., Foss, A., Line, P. D., Sanengen, T., Bergmann, G. B., Ohlin, P., Wælgaard, L., Grindheim, G., Pischke, S. E., Mollnes, T. E. and Tønnessen, T. I. (2013), Clinical experience with microdialysis catheters in pediatric liver transplants. Liver Transpl, 19: 305–314. doi: 10.1002/lt.23578
The study was financially supported by the South-Eastern Norwegian Health Authority (through grants 2009007 and 2008104).
- Issue published online: 11 MAR 2013
- Article first published online: 11 MAR 2013
- Accepted manuscript online: 29 NOV 2012 05:12AM EST
- Manuscript Accepted: 7 NOV 2012
- Manuscript Received: 29 AUG 2012
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 = 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 = 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 = 1-7 days) before alanine aminotransferase increased (n = 5, P = 0.11), at a median of 4 days (range = 2-9 days) before total bilirubin increased 25% or more (n = 7, P = 0.04), and at a median of 6 days (range = 4-11 days) before biopsy was performed (n = 8, P = 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. Liver Transpl 19:305–314, 2013. © 2013 AASLD.