Intraoperative lactate level and lactate clearance is associated with long-term mortality in liver transplant recipients

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BACKGROUND: Hyperlactatemia has been associated with poor outcomes in various clinical settings including liver transplantation (LT). However, the impact of intraoperative lactate levels and lactate clearance on long-term mortality in LT recipients remains unclear. METHODS: We retrospectively reviewed data from 1,067 patients who underwent LT. All lactate data measured intraoperatively were used to calculate the time-weighted average lactate (TWAL) method. Lactate clearance was calculated as the difference between lactate levels immediately after reperfusion and at the end of surgery. Multivariable analyses were performed to identify independent predictors of mortality after LT. RESULTS: Higher lactate group showed significantly worse survival at 30-days, 1-year, and 3-years (P = 0.01, P < 0.001, and P < 0.001, respectively), and lactate clearance was significantly lower in non-survivors (P = 0.003, P = 0.003, and P = 0.002, respectively). Multivariable analyses revealed that the TWAL was independently associated with each mortality timepoint (hazard ratio [HR], 1.41, 95% confidence interval [CI], 1.19-1.67; P < 0.001, HR, 1.29, 95% CI, 1.17-1.42; P < 0.001, HR, 1.20, 95% CI, 1.10-1.30; and P < 0.001, respectively). Furthermore, lactate clearance was also an independent predictor for each mortality timepoint (HR, 0.69, 95% CI, 0.60-0.80; P < 0.001, HR, 0.80, 95% CI, 0.73-0.88; P < 0.001, and HR, 0.83, 95% CI, 0.77-0.90; P < 0.001, respectively). CONCLUSIONS: Both intraoperative lactate level and lactate clearance were independently associated with mortality after LT. Intraoperative lactate monitoring may help predict both short- and long-term mortality in LT recipients.