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Abstract：
The current clinical practice of assessing the quality and suitability of a donor liver for human transplantation does not exclude cases of primary graft dysfunction of the transplanted organ and, at the same time, leads to an unreasonable refusal to transplant a significant number of functionally suitable organs. In this regard, searching for new methods for additional objective assessment and monitoring of the state of donor organs in the peritransplant period is relevant. The aim of the study was to determine the clinical utility of monitoring interstitial concentrations of glucose and its metabolites to assess the viability and functional state of a donor liver before and after human transplantation.
A retrospective observational single-center study included 32 cases of liver transplantation. Along with standard methods for assessing the initial function of grafts during the first week after surgery, interstitial (in the transplanted liver) concentrations of glucose and its metabolites were monitored. In 18 cases, the interstitial glucose metabolism was also studied during static cold storage (SCS).
With the development of early allograft dysfunction (EAD), compared with the uneventful post-transplant period, statistically significantly higher interstitial lactate concentrations were observed as early as 3 h after reperfusion: 12.3 [10.1; 15.6] mmol/L versus 7.2 [3.9; 9.9] mmol/L (p=0.003). A value above 8.8 mmol/L may be considered as a criterion for the immediate diagnosis of EAD (sensitivity - 89%, specificity - 65%).Interstitial lactate concentration at the end of SCS and the area under the \"lactate concentration-SCS duration\" curve were associated with the initial graft function. Values of these parameters greater than 15.4 mmol/L and 76.1 mmol/L·h, respectively, with a sensitivity of 100% in both cases and a specificity of 77 and 85%, may be used to assess the risk of primary EAD.
Monitoring of interstitial concentrations of glucose and its metabolites, primarily, lactate, is an objective additional method for the assessment of the donor liver viability both during SCS and in the early postoperative period.
A retrospective observational single-center study included 32 cases of liver transplantation. Along with standard methods for assessing the initial function of grafts during the first week after surgery, interstitial (in the transplanted liver) concentrations of glucose and its metabolites were monitored. In 18 cases, the interstitial glucose metabolism was also studied during static cold storage (SCS).
With the development of early allograft dysfunction (EAD), compared with the uneventful post-transplant period, statistically significantly higher interstitial lactate concentrations were observed as early as 3 h after reperfusion: 12.3 [10.1; 15.6] mmol/L versus 7.2 [3.9; 9.9] mmol/L (p=0.003). A value above 8.8 mmol/L may be considered as a criterion for the immediate diagnosis of EAD (sensitivity - 89%, specificity - 65%).Interstitial lactate concentration at the end of SCS and the area under the \"lactate concentration-SCS duration\" curve were associated with the initial graft function. Values of these parameters greater than 15.4 mmol/L and 76.1 mmol/L·h, respectively, with a sensitivity of 100% in both cases and a specificity of 77 and 85%, may be used to assess the risk of primary EAD.
Monitoring of interstitial concentrations of glucose and its metabolites, primarily, lactate, is an objective additional method for the assessment of the donor liver viability both during SCS and in the early postoperative period.
摘要：
目前的临床实践中，评估供者肝脏移植的质量和适用性并不排除移植器官原发性移植物功能障碍的病例，同时,导致不合理地拒绝移植大量功能合适的器官。在这方面,寻找新的方法来进行额外的客观评估和监测移植期间的供体器官状态是相关的。该研究的目的是确定监测葡萄糖及其代谢物的间质浓度以评估人类移植前后供体肝脏的活力和功能状态的临床实用性。
■一项回顾性观察性的单中心研究包括32例肝移植。除了评估手术后第一周移植物初始功能的标准方法外，监测间质（在移植的肝脏中）葡萄糖及其代谢物的浓度。在18个案例中，还研究了静态冷藏（SCS）期间的间质葡萄糖代谢。
■随着早期同种异体移植功能障碍（EAD）的发展，与平稳的移植后时期相比，早在再灌注后3小时就观察到有统计学意义的更高的间质乳酸浓度:12.3[10.1;15.6]mmol/L与7.2[3.9;9.9]mmol/L(p=0.003).高于8.8mmol/L的值可被视为立即诊断EAD的标准（灵敏度-89％，特异性-65%)。SCS末端的间质乳酸浓度和“乳酸浓度-SCS持续时间”曲线下的面积与初始移植物功能相关。这些参数值大于15.4mmol/L和76.1mmol/L·h，分别,在这两种情况下的灵敏度均为100％，特异性为77％和85％，可用于评估原发性EAD的风险。
■葡萄糖及其代谢物间质浓度的监测，主要是,乳酸，是评估SCS期间和术后早期供体肝脏活力的客观附加方法。
■一项回顾性观察性的单中心研究包括32例肝移植。除了评估手术后第一周移植物初始功能的标准方法外，监测间质（在移植的肝脏中）葡萄糖及其代谢物的浓度。在18个案例中，还研究了静态冷藏（SCS）期间的间质葡萄糖代谢。
■随着早期同种异体移植功能障碍（EAD）的发展，与平稳的移植后时期相比，早在再灌注后3小时就观察到有统计学意义的更高的间质乳酸浓度:12.3[10.1;15.6]mmol/L与7.2[3.9;9.9]mmol/L(p=0.003).高于8.8mmol/L的值可被视为立即诊断EAD的标准（灵敏度-89％，特异性-65%)。SCS末端的间质乳酸浓度和“乳酸浓度-SCS持续时间”曲线下的面积与初始移植物功能相关。这些参数值大于15.4mmol/L和76.1mmol/L·h，分别,在这两种情况下的灵敏度均为100％，特异性为77％和85％，可用于评估原发性EAD的风险。
■葡萄糖及其代谢物间质浓度的监测，主要是,乳酸，是评估SCS期间和术后早期供体肝脏活力的客观附加方法。
