Analysis Of The Influencing Factors Of Perioperative Hyperlacticemia In Liver Transplantation And Its Relationship With Patient Prognosis

Objective: We aim to analyze the risk factors for perioperative hyperlacticemia in liver transplantation,explore its relationship with patient prognosis,and provide a basis for effective clinical preventive measures.Method: 120 patients who performed liver transplantation at the Affiliated Hospital of Qingdao University between January 2021 and December 2021 were the subject of a retrospective data study.Statistics were applied to the laboratory indicators before,during,and after the operation.Univariate analysis uses χ2 test,t-test,or nonparametric test,multivariate analysis applies logistic regression models.Results: The results showed that variations in five indices,including alanine aminotransferase(ALT),aspartate aminotransferase(AST),albumin(ALB),the international normalized ratio(INR)and prothrombin time(PT)were consistent with the lactic acid fluctuation.Preoperative hyperlactatemia will affect liver transplantation surgery and prognosis,and is related to primary disease,smoking history,Child score,Meld score,preoperative total bilirubin(TB),white blood cell(WBC),hemoglobin(HB),ALT,AST,PT,INR;Preoperative LAC ≥2mmol/L,intraoperative LAC peak or postoperative LAC ≥5mmol/L prolongs the ICU stay;Patients with preoperative LAC ≥2mmol/L,intraoperative LAC peak,or postoperative LAC ≥5 mmol/L had higher mortality rates than those with lower LAC values,but the difference was not statistically significant.Univariate analysis showed:The length of the anhepatic phase,total intraoperative intake,intraoperative hemorrhage and intraoperative blood transfusion(red blood cells)were all shown to be related with severe hyperlactatemia after liver transplantation.Multivariate logistic regression analysis revealed that the length of the anhepatic phase [OR = 1.048,95% confidence interval(CI): 1.007～1.092,p < 0.05] and the amount of red blood cells[OR=1.179,95%CI:1.019～1.364,p < 0.05] were both independent risk factors for severe hyperlactatemia.Conclusion: 1.The change trend of perioperative LAC in liver transplantation was consistent with ALT,AST,ALB,INR,PT,reflecting that the production and metabolism of LAC in the perioperative period of liver transplantation were closely related to perioperative liver function;2.Hyperlacticemia before liver transplantation will cause increased blood loss and red blood transfusion during liver transplantation,and will also prolong the length of ICU hospitalization,and patients with hyperlacticemia before liver transplantation tend to have worse liver function;3.Preoperative LAC ≥2mmol/L,intraoperative LAC peak or postoperative LAC ≥5mmol/L prolongs the ICU stay;4.Long anhepatic phase and severe intraoperative anaemia are independent risk factors for severe hyperlactemia after liver transplantation.