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Published on: January 11, 2013
Surface microdialysis to monitor hepatic metabolism in liver surgery
Niklas Löfgren1, Per-Jonas Blind1, Hanna Nyström2
1Department of Diagnostics and Intervention, Surgery, Umeå University, Umeå, Sweden.
Background:
Microdialysis (μD) monitors local metabolism in tissues. Traditional μD requires intraparenchymal catheters, risking tissue damage, interfering with the analysis. This study evaluated the safety and feasibility of monitoring liver metabolism with a novel surface μD probe after liver resection.
Methods:
Two μD catheters were attached to the liver surface intraoperatively. Concentrations of glucose, lactate, and pyruvate were determined and related to venous blood samples. Complications were registered 30 days postoperatively and graded according to Clavien-Dindo Classification and CTCAE guidelines.
Results:
Samples were collected for a median of 4.7 days in 17 patients. No major complications related to μD were observed. The coefficients of variation for glucose, lactate, pyruvate, and the lactate/pyruvate ratio (L/P) were 18 %, 22 %, 28 %, and 21 %. Lactate in liver μD was significantly higher than in plasma and further increased in an ischemic area. Postoperative μD L/P was significantly correlated to a later increase in alanine aminotransferase. μD sampling from a hepatocellular carcinoma indicated elevated lactate compared with healthy liver.
Conclusions:
Surface μD is a safe and feasible method to monitor liver metabolism postoperatively and may survey tumour metabolism in vivo. Biomarker trends can be monitored in vivo and may precede changes in systemic venous samples.
