Interstitial lactic acidosis in the graft during organ harvest, cold storage, and reperfusion of human liver allografts predicts subsequent ischemia reperfusion injury

Background. The impact of the process of liver transplantation on glucose metabolism in the graft was studied using microdialysis. Methods. Microdialysis catheters were inserted into 15 human livers to monitor metabolic changes that took place during organ harvest, the process of backtable preparation of the graft, and following implantation in the recipient where it remained in situ for 48 hours. The cannula was perfused with isotonic solution and hourly samples of perfusate were collected and analyzed. Results. Six livers showed serum biochemical evidence of ischemia/reperfusion (IR) injury with 24 hours aspartate transaminase (AST) levels > 2000 IU/L (Group A) whereas the remaining patients showed little evidence of IR injury (Group B). In Group A, lactate levels in the donor microdialysate rose to > 6 mM (P <0.05), were significantly higher during backtable preparation of the liver (> 15 mM; P <0.03), and took longer to normalize in the recipient following implantation (18 vs. 8 hours, P <0.03) than lactate levels of the livers of patients in Group B who did not develop ischemia reperfusion injury. No significant differences were observed in glucose, pyruvate, or glycerol concentrations between the two groups. Conclusions. Interstitial lactic acidosis in the donor allograft is associated with significant reperfusion injury on implantation.