Year 2020 Vol. 28 No 6

TRANSPLANTOLOGY

D.A. FEDARUK 1, K.I. PETRENKO 1, L.V. KIRKOVSKY 1, D.N. SADOUSKY 1, V.A. LEBEDZ 2, A.F. CHICHVA 2, YE.V. FILIPENKO 2, S.Z. SHARIPOV 1, A.M. FEDARUK 1, O.O. RUMMO 1

BILE LACTATE AS A MARKER OF BALLOONING DEGENERATION OF HEPATOCYTES AND A POTENTIAL CRITERION FOR CHOOSING A METHOD OF LIVER TRANSPLANT PRESERVATION

Minsk Scientific and Practical Center for Surgery, Transplantology and Hematology 1
Minsk Municipal Clinical Pathology Bureau 2, Minsk,
The Republic of Belarus

Objective. To determine the diagnostic value of donors bile as a marker allowing to give an additional assessment, objectify the state of the liver graft, assess the need for dynamic air conditioning, and predict the course of the early postlesional period.
Methods. From July 2017 to November 2019 the bile intake from choledoch and biopsy from liver parenchyma were performed during the explantation operation. All grafts were divided into 2 groups. The first group consisted of organs intented for further transplantation and the organs of the second group were considered unfit for transplantation. Bile ABS (acid-based state) and morphological analysis of transplants were carried out in both groups.
Results. A reliable relationship between the level of bile lactate of both groups and the level of hepatocellular ballooning (R=0.50, p=0.001) was determined. In those cases where severe hepatocyte ballooning was observed the higher levels of lactate in the bile of donors 1.9 [1.2; 2.55] were reliably determined in comparison with those specimens where it was not expressed 0.6 [0.3; 1.7] (p=0.006). The performed ROC analysis allowed determining the level of bile lactate at 1 mmol/ L as a cut-off point at which the probability of liver hepatocyte ballooning is maximal (AUC=0.830). In group 1, a reliable association was obtained between the level of donor bile lactate and ALT at the peak value (R=0.56, p=0.004) and on the 7th postoperative day (R=0.53, p=0.01), as well as with the INR level at the peak value (R=0.63, p=0.001).
Conclusion. Bile lactate reliably reflects the degree of hepatocyte ballooning and objectifies the state of donor liver, as well as predicts the course of the early postoperative period. Bile lactate level greater than 1 mmol/L is a potential criterion for oxygenated machine perfusion.

Keywords: bile lactate, ballooning, transplantation, preservation, machine perfusion
p. 671-679 of the original issue
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Address for correspondence:
220045, Republic of Belarus,
Minsk, Semashko Str., 8,
Minsk Scientific and Practical Center for Surgery, Transplantology and Hematology,
the Trasplantology Department,
Tel..: +375 29 604 88 10
e-mail: tetrafed@yandex.ru
Fedaruk Dzmitry A.
Information about the authors:
Fedaruk Dzmitry A., Surgeon, Minsk Scientific and Practical Center for Surgery, Transplantology and Hematology, Minsk, Republic of Belarus.
http://orcid.org/0000-0002-9686-1950
Petrenko Kristina I., Head of the Clinical-Diagnostic Laboratory, Minsk Scientific and Practical Center for Surgery, Transplantology and Hematology, Minsk, Republic of Belarus.
http://orcid.org/0000-0002-4127-3588
Kirkovsky Leanid V., PhD, Deputy Director for Medical Affairs for Civil Defense and Mobilization Work, Minsk Scientific and Practical Center for Surgery, Transplantology and Hematology, Minsk, Republic of Belarus.
http://orcid.org/0000-0002-7852-4555
Sadouski Dzianis N., PhD, Surgeon, Minsk Scientific and Practical Center for Surgery, Transplantology and Hematology, Minsk, Republic of Belarus.
http://orcid.org/0000-0002-6351-1006
Lebedz Volha A., Pathologist, Minsk Municipal Clinical Pathology Bureau, Minsk, Republic of Belarus.
http://orcid.org/0000-0002-6972-9903
Chichva Artur F., Pathologist, Minsk Municipal Clinical Pathology Bureau, Minsk, Republic of Belarus.
http://orcid.org/0000-0002-0130-5004
Filipenka Ekatserina V., Pathologist, Minsk Municipal Clinical Pathology Bureau, Minsk, Republic of Belarus.
http://orcid.org/0000-0003-4899-5724
Sharipov Shohrat Z., Head of the Thoracic Department, Minsk Scientific and Practical Center for Surgery, Transplantology and Hematology, Minsk, Republic of Belarus.
http://orcid.org/0000-0003-2754-043X
Fedaruk Aliaksei M., MD, Head of the Department of Hepatology and Minimally Invasive Surgery, Minsk Scientific and Practical Center for Surgery, Transplantology and Hematology, Minsk, Republic of Belarus.
http://orcid.org/0000-0001-9211-8396
Rummo Oleg O., MD, Professor, Corresponding Member of NAS of Belarus, Head of Minsk Scientific and Practical Center for Surgery, Transplantology and Hematology, Minsk, Republic of Belarus.
http://orcid.org/0000-0001-7023-4767
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