| Objective:To observe early liver metabolism changes(glucose,lactate,glycerol, pyruvate) and prognosis of complications at bedside by continuous graft monitoring with microdialysis in patients with end-stage liver disease undergoing orthotopic transplantation. Methods:Nine consecutive patients undergoing whole-organ orthotopic liver transplantation were studied.At the end of the operation intrahepatic implantation of a microdialysis catheter was placed in segmentⅥin the direction of segmentⅧat the level of falciform ligament.A reference catheter was placed in the subcutaneous adipose tissue immediately after abdominal closure.Consecutive serial samples were collected at 1-hour intervals after the operation. Sampling was continued until the patient went out of the ICU,about 5～7days.Glucose,lactate, pyruvate and glycerol concentrations were measured.Meanwhile patients did some routine examinations and were observed continually.Besides,these patients were followed up after they were discharged.Results:1.Liver tissue:The mean level of glucose increased gradually to 10.12±4.08mmol / L from 5.13±4.03mmol / L within the first 12 hours postoperarion,after that,it fluctuated about 8.12±1.08mmol / L.The mean level of glycerol climbed gradually upto 97.76±151.07umol / L from 19.52±14.53umol / L,and with a peak level of 653.79±371.32umol / L in the 108th hour.At the same time,regression equation indicated the mean level of glycerol is an important factor to the mean level of liver enzymes(ALT,AST),the regression equation was ALT = 93.83 +0.68 Glycerol,AST =- 216.26 +0.60 Glycerol respectively.The mean level of lactic acid reached rapidly 3.47±1.00mmol / L from 2.04±1.36mmol / L,after that,it decreased gradually.The mean level of pyruvate fluctuated around 195.56±127.58umol/L within the first 14 hours postoperation,and reached 370±177.13umol/L at the 93rd hour.The lactate/pyruvate ratio increased rapidly to 10.12±4.08mmol / L from 5.13±4.03mmol / L within the first 14 hours postoperarion,thereafter,it reamained stabile at 10.00～15.00.2.Liver tissue and subcutaneous reference:during the time of microdialysis monitoring,the level of liver group's glycerol,lactate/pyruvate ratio is greater than the subcutaneous's,while the level of liver group's glucose,lactate and pyruvate is less than the subcutaneous's(P＜0.05).3.During the time of microdialysis monitoring,the level of liver enzymes(ALT,AST) have a statistically significant,and group A is greater than group B(P＜0.05).Conclusions:1.The procedure of microdialysis is easy to perform and safe,and it can be used without causing obvious discomfort,lntrahepatic microdialysis can provide us a good way of study early graft metabolism after liver transplantation.And then we can detect early biochemical changes of the transplant liver from cell level of extracellular fluid;2.We can predict the occurrence of early complications of the graft before clinical signs,including changes in blood biochemical indicators and clinical symptoms,and to assess the prognosis of patients;3.There is a certain relevance between the level of glycerol and enzyme of the graft. Therefore,when it happen to increase early the level of graft glycerol,excluding factors of system,it can be used as a symbol of liver cells damage,and suggesting that the liver occurred early complications(such as:rejection complications,ischemic vascular complications and bile duct complications,etc.);4.In the early time of postoperation,when a significantly higher level of glycerol emerged,while lactate / pyruvate ratio stabilized at a low level(so called isolated elevation of glycerol ),it will indicate that acute rejection complications of the liver has happened.5.In the early time of postoperation,a significantly higher level of glycerol and lactate/pyruvate ratio mean the existence of the ischemic complications,excluding factors of system,such as hypoxia and ischemia.
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