AKBR in Liver Transplantation

Abstract

Since sufficient energy production is essential to promote many cellular functions of the liver, evaluation of the energy producing capacity of hepatic mitochondria is expected to give crucial prognostic information regarding the early posttransplant graft function. Arterial ketone body ratio (AKBR) is known to be a parameter that shows whether the liver produces energy adequately in many complicated circumstances. (Objectives) This study was conducted to see whether the AKBR could be added in te surveillance armaments of graft function during the early postoperative periods. (Materials and methods) AKBR was measured in 8 of 9 patients who underwent OLT during the period from March 1992 through December 1993. All the donor operations were done by standard in-situ perfusion technique. University of Wisconsin(UW) solution was used in all ases except one. The mean age of recipients was 38 years and male-to-female ratio was 6:2 . Venovenous bypass was used for the recipient operation. Immunosuppressants used were cyclosporine and steroid in 3 cases and FK 506 and steroid in 5.(Results) During the anhepatic stage, AKBR fell below 0.4 in 7 cases, and between 0.4 and 0.7 in one. There was a prompt improvement in AKBR as soon as portal reperfusion was initiated. Restoration of AKBR to above 0.7 wa observed at the completion of operation in 5 cases, while in the remaining 3 patients it recovered within 24 hours after operation. There was no primary onfunction of he graft, which seems to correlate with the findins that AKBR's in all cases were above 0.7 during the immediate postoperative period (7 days). The survivors had maintained AKBR value of 0.7 or more throughout the recovery period (up to 30 days). In contrast, an abrupt reduction in ADBR below 0.4 preceded the death of 2 patients by 2 to 3 days. (Conclusion) AKBR measurement can provide information for rapid assessment of the functional state of the allograft.