| Aim The objective is to permit continuous monitoring of metabolic changes in the transplanted liver at the bedside.Methods Five 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 segment IV in the direction of segment V or VIII at 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-h 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 During the monitoring period, the glucose level was higher in the liver than in the reference tissue, and the glucose level in the liver changed with that in blood, while the lactate level and the lactate: pyruvate ratio were higher in the reference tissue than in the liver. During the first 24h, the glycerol level was higher in the reference tissue than in the liver, but 84h later, the glycerol level was higher in the liver than in the reference tissue. A decrease of the glycerol level in the reference tissue was observed and remained stable later.Conclusions The procedure of microdialysis is easy to perform and safe, and it can be used without causing important discomfort. It allows continuous monitoring of tissue metabolism in the transplantation graft. Microdialysis, as a bedside analysis method, also provides quick information, which could be of crucial importance in diagnosis of complications and making fast clinical decisions. The rapid increase of the glycerol level two or three days after the operation may indicate the acute rejection of the transplanted liver. |
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