1. Predictive value of early postoperative lactate (<6 h) during normothermic machine perfusion and outcome after liver transplantation: results from a multicentre study.
- Author
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Hofmann, Julia, Meszaros, 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, and Schneeberger, Stefan
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LIVER transplantation , *LACTATES , *LACTATION , *TREATMENT effectiveness , *PERFUSION , *HOMOGRAFTS , *MYOCARDIAL perfusion imaging - Abstract
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. Biomarkers with strong predictive capacity towards transplantation outcome for livers undergoing normothermic machine perfusion are needed. We investigated lactate clearing capacity as a basic function of liver viability during the first 6 hours of NMP in a multicentre trial in 509 livers and found the absolute lactate concentration at 6h, the AUC of 0-6h and 1-6h were the strongest predictors of clinical outcome. Monitoring lactate levels should be extended to at least 6h of NMP routinely to improve clinical outcome. [ABSTRACT FROM AUTHOR]
- Published
- 2024
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