Utility of Basal Regional Oximetry as an Early Predictor of Graft Failure After Liver Transplant

Adequate perfusion and oxygenation to liver graft after transplantation is essential for its viability. Hepatic oximetry (hepatic tissue oxygenation [LSrO₂]) through near infrared spectroscopy (NIRS) can help by showing real time oxygen content of the graft.

In this prospective study, we enrolled 50 consecutive patients undergoing liver transplant surgery from deceased donors. Liver NIRS (LSrO₂) was continuously measured for 24 hours then analyzed and correlated with other clinical data such as hemoglobin (Hb), mixed venous oxygen saturation, cardiac index (CI), central venous pressure, arterial gases, diuresis, blood lactate, liver biochemistry, and normalized index ratio (INR). Severity disease scales and cold-warm ischemia time were also measured, as well as Doppler ultrasound (DUS) at hour 24. A statistical analysis with IBM SPSS 22 using Pearson correlation was carried out.

LSrO₂ could anticipate serious bleeding and hemodynamic events showing a decrease >10% from basal data. We found a significant correlation between LSrO₂ with CI at 3 hours (P=.044), hemoglobin (Hb) at hour 3 and 24 (P = .004 and P = .002, respectively), and with Apache II (P=.041). A significant correlation was also detected between cold ischemia and INR at hour 24 (P=.016). No correlation of LSrO₂ was found with lactate, liver biochemistry, and DUS data.