Special features of interstitial glucose metabolism in early liver allograft dysfunction

Background. The assessment of liver allograft viability and continuous monitoring of its function are of crucial importance, especially early after transplantation. Identification of the special fea- tures of graft interstitial glucose metabolism with microdialysis technique is one of the possible diagnostic approaches.

Aim – to determine the incidence of early allograft dysfunction (EAD) and primary non-function (PNF) in the retrospective single-center cohort of deceased donor liver transplants and explore the patterns of graft interstitial glucose, lactate and pyruvate concentrations, depending on initial graft function in prospective recruiting cases.

Material and methods. The retrospective part of the study contains data about 65 liver transplants, consistently performed since May 2012 to March 2018. Initial graft function was assessed with common laboratory and clinical criteria within first postoperative week. In prospective cases (n=7, since April 2018 to September 2018) collection of microdialysis samples was started immediately after arterial reperfusion and continued for 7 days or until recipient’s death. Routine blood biochemistry and coagulation tests were performed at least once a day in both groups.

Results. The incidences of EAD and PNF in retrospective cohort were 20% (13/65) and 5% (3/65), respectively. In prospective series all types of initial graft function were observed: normal function – 4, EAD – 2, PNF – 1. With normal initial graft function and uncomplicated postoperative course, interstitial glucose (GLU), lactate (LAC) and pyruvate (PYR) concentrations remained stable and ranged from 5 to 20 mmol/L, 1.0–7.5 mmol/L, 60–400 μmol/L, respectively. EAD was characterized by initially higher (2–3 times) levels of GLU, LAC, PYR. In the case of hepatic artery thrombosis within 2–4 hours 5-fold increase in interstitial LAC concentration was recorded with a simultaneous decrease in the concentration of GLU to 0.1 mmol/L and PYR to 11 μmol/L. In PNF graft initially high concentration of interstitial LAC (16.4 mmol/L) and its further increase to 35.5 mmol/L was observed, the concentration of GLU was close to 0.

Conclusion. Poor initial liver graft function is common (25%) complication of the deceased-donor liver transplantation. Microdialysis measurement of interstitial glucose, lactate, pyruvate and glycerol concentrations allows continuous real-time graft viability and function monitoring. High sensitivity of the method could accelerate the diagnosis of vascular complications, in particular, hepatic artery thrombosis, as well as other etiology graft dysfunction.

1. Olthoff K.M., Kulik L., Samstein B., Kaminski M., et al. Validation of a current definition of early allograft dysfunction in liver transplant recipients and analysis of risk factors. Liver Transpl. 2010; 16 (8): 943–9. doi: 10.1002/lt.22091. PubMed PMID: 20677285.

2. United Network For Organ Sharing. United Network for Organ Sharing Liver Disease Severity Score Com- mittee. 2014. URL: www.unos.org.

3. Chen X.B., Xu M.Q. Primary graft dysfunction after liver transplantation. Hepatobiliary Pancreat Dis Int. 2014; 13 (2): 125–37. PubMed PMID: 24686540.

4. Nowak G., Ungerstedt J., Wernerman J., Unger- stedt U., et al. Clinical experience in continuous graft monitoring with microdialysis early after liver transplantation. Br J Surg. 2002; 89 (9): 1169–75. PubMed PMID: 12190684.

5. Haugaa H., Almaas R., Thorgersen E.B., Foss A., et al. Clinical experience with microdialysis catheters in pediatric liver transplants. Liver Transpl. 2013; 19 (3): 305–14. doi: 10.1002/lt.23578. PubMed PMID: 23193034.