Can joint analysis of postoperative MELD, base excess and blood lactate levels be used as an index of postoperative outcome for patients submitted to liver transplantation?

Abstract

A análise conjunta do MELD pós-operatório, do base excess e dos níveis séricos de lactato pode ser usada como um índice prognóstico para pacientes submetidos a transplante de fígado? ABSTRACT PURPOSE:The objective of the present study was to evaluate the postoperative levels of classical or pure MELD and changes in lactate or base excess (BE) levels as possible predictive factors of the type of outcome of patients submitted to orthotopic liver trasplantation (OLT). METHODS:The study was conducted on 60 patients submitted to OLT at the University Hospital, Faculty of Medicine of Ribeirão Preto, USP, between October 2008 and March 2012. The 30 latest survivor (S) and non-survivor (NS) cases were selected.All liver transplants were performed using the piggy-back technique. ALT, AST, BE and blood lactate values were determined for each group at five time points (immediate preoperative period, end of hypothermal ischemia, 5 and 60 minutes after arterial revascularization and in the immediate postoperative period, when the postoperative MELD was also calculated. RESULTS:The aminotransferases reached a maximum increase 24 hours after surgery in both the S and NS groups. There was a significantly higher increase in BE and blood lactate in the NS group, especially after 5 minutes of afterial reperfusion of the graft, p<0.05. There was no significant difference in preoperative MELD between groups (p>0.05), while the postoperative MELD was higher in the NS than in the S group (p<0.05) CONCLUSION: Joint analysis of postoperative MELD, BE and blood lactate can be used as an index of severity of the postoperative course of patients submitted to liver transplantation. . Avaliou-se para cada grupo, os valores ALT, AST, de base excess (BE) e lactato sanguíneos em cinco momentos (pré-operatório imediato, no final da isquemia hipotérmica, 5 e 60 minutos após a revascularização arterial e no pós-operatório imediato, quando também foi calculado o MELD pós-operatório. RESULTADOS:Com relação às aminotransferases, houve um aumento máximo após 24 horas de pós-operatório em ambos os grupos S e NS. Houve aumento significativo dos níveis de BE e lactato sanguíneo significativamente maior no grupo NS, sobretudo nos tempos após 5 minutos de reperfusão arterial do enxerto, p<0,05. Não houve diferença significativa entre o MELD pré-operatório em ambos os grupos (p>0,05). O MELD pós-operatório foi maior no grupo NS do que no grupo S (p<0,05). CONCLUSÃO:A análise conjunta do MELD pós-operatório, do BE e do lactato sanguíneo pode ser usada como índice de gravidade da evolução pós-operatória de pacientes submetidos ao OLT.Descritores: Ácido Láctico, Transplante de Fígado, Índice de gravidade de doença, Prognóstico.

A New Formula as a Predictive Score of Post–Liver Transplantation Outcome: Postoperative MELD-Lactate

“…However, the dispersal of lactate levels was very high in the nonsurvivor group (7.28 AE 5.91 mmol/L), a fact that may impair its use as a predictive index of the type of postoperative evolution in OLT. This wide dispersal of values was already observed in a study previously published by our group [15,37].…”

“…In a series of previous investigations, it has been shown that a joint analysis of the original postoperative MELD score, base excess, and blood lactate can be used as an index of the severity of the postoperative course of patients submitted to liver transplantation [15,37]. In this study, significantly higher blood lactate levels were observed after surgery in nonsurvivors compared to survivors, a fact that demonstrates the cause-effect relationship with the postoperative course of transplanted patients.…”

Prognostic Value of Procalcitonin, CRP, Serum Amyloid A, Lactate and IL-6 Markers in Liver Transplant Patients Admitted to ED with Suspected Infection

“…In the same study, the effect of lactate level on mortality was determined and it was found that the effect on mortality was insignificant (p>0.05) (22).…”

Fluorescence spectroscopy for clinical transplantation liver grafts monitoring: possibilities offered by 408 nm excitation

“…In spite of the volume of information provided, it was not possible to establish a direct correlation between the several aspects assessed by blood biochemistry and fluorescence. However, only the relative variation of lactate (Lac) and prothrombin (INR) before and after procedures showed a correlation with the survival status of patients 15 , 16 . Expressive and simultaneous variation in the relative levels of both parameters was evident for most deceased patients, in contrast to surviving patients.…”