BACKGROUND:Initial poor graft function(IPGF)following orthotopic liver transplantation is a major determinant of postoperative survival and morbidity.Lactate clearance is a good marker of liver function.In this study,...BACKGROUND:Initial poor graft function(IPGF)following orthotopic liver transplantation is a major determinant of postoperative survival and morbidity.Lactate clearance is a good marker of liver function.In this study,we investigated the clinical utility of early lactate clearance as an early and accurate predictor for IPGF following liver transplantation.METHODS:This was a prospective observational study of 222 patients referred to the surgical intensive care unit(SICU)after orthotopic liver transplantation.The IPGF group consisted of patients with alanine aminotransferase(ALT)and/or aspartate aminotransferase(AST)>1500 IU/L within 72 hours after orthotopic liver transplantation.Early lactate clearance was defined as lactate at SICU presentation(hour 0)minus lactate at hour 6,divided by lactate at SICU presentation.The model for end-stage liver disease(MELD)score,Child-Pugh score and laboratory data including AST,ALT,total bilirubin(TB)and prothrombin time(PT)were recorded at SICU presentation and compared between the non-IPGF and IPGF groups Receiver operating characteristic(ROC)curves were plotted to measure the performance of early lactate clearance,MELD score,Child-Pugh score,TB and PT.RESULTS:IPGF occurred in 45 of the 222 patients(20.3%).The early lactate clearance in the non-IPGF group was markedly higher than that in the IPGF group(43.2±13.8%vs 13.4±13.7%P<0.001).The optimum cut-off value for early lactate clearance predicting IPGF was 24.8%(sensitivity 95.5%,specificity 88.9%).The area under the curve of the ROC was 0.961,which was significantly superior to MELD score,Child-Pugh score TB and PT.Patients with early lactate clearance≤24.8%had a higher IPGF rate(OR=169)and a higher risk of in-hospital mortality(OR=3.625).CONCLUSIONS:Early lactate clearance can serve as a prompt and accurate bedside predictor of IPGF.Patients with early lactate clearance less than 24.8%are associated with a higher incidence of IPGF.展开更多
基金supported by grants from the Natural Science Foundation of Guangdong Province(8151008901000079)the Sun Yat-Sen University Clinical Research 5010 Program(2007015)
文摘BACKGROUND:Initial poor graft function(IPGF)following orthotopic liver transplantation is a major determinant of postoperative survival and morbidity.Lactate clearance is a good marker of liver function.In this study,we investigated the clinical utility of early lactate clearance as an early and accurate predictor for IPGF following liver transplantation.METHODS:This was a prospective observational study of 222 patients referred to the surgical intensive care unit(SICU)after orthotopic liver transplantation.The IPGF group consisted of patients with alanine aminotransferase(ALT)and/or aspartate aminotransferase(AST)>1500 IU/L within 72 hours after orthotopic liver transplantation.Early lactate clearance was defined as lactate at SICU presentation(hour 0)minus lactate at hour 6,divided by lactate at SICU presentation.The model for end-stage liver disease(MELD)score,Child-Pugh score and laboratory data including AST,ALT,total bilirubin(TB)and prothrombin time(PT)were recorded at SICU presentation and compared between the non-IPGF and IPGF groups Receiver operating characteristic(ROC)curves were plotted to measure the performance of early lactate clearance,MELD score,Child-Pugh score,TB and PT.RESULTS:IPGF occurred in 45 of the 222 patients(20.3%).The early lactate clearance in the non-IPGF group was markedly higher than that in the IPGF group(43.2±13.8%vs 13.4±13.7%P<0.001).The optimum cut-off value for early lactate clearance predicting IPGF was 24.8%(sensitivity 95.5%,specificity 88.9%).The area under the curve of the ROC was 0.961,which was significantly superior to MELD score,Child-Pugh score TB and PT.Patients with early lactate clearance≤24.8%had a higher IPGF rate(OR=169)and a higher risk of in-hospital mortality(OR=3.625).CONCLUSIONS:Early lactate clearance can serve as a prompt and accurate bedside predictor of IPGF.Patients with early lactate clearance less than 24.8%are associated with a higher incidence of IPGF.
