الفهرس 
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Abstract
Initial poor graft function (IPGF) following orthotopic liver transplantation (LT) causes complications, which result in poor prognosis. This study was performed to evaluate if intraoperative changes in blood lactate level and venous oxygen saturation (ScvO2) after hepatic allograft reperfusion can reflect Initial Poor Graft Function (IPGF) following LT. This prospective observational cohort study of 40 recipients was studied. Patient State Index (PSI), SED Line (Masimo, Irvine, CA) monitored anaesthesia depth (25-50) with Desflurane (Des) % and fentanyl altered accordingly. Transoesophageal Doppler (TED) (CardioQ, Chichester, UK), invasive mean arterial blood pressure (MABP, mmHg) and heart rate (HR, beat/min) were monitoring; TED was used for fluid optimization. Intraoperative serum lactate and daily collection of serum and plasma samples were taken to provide aliquots for routine biochemistry analysis, liver function test. Results: Initial Poor Graft Function (IPGF) occurred in 4 of the 40 patients (10%). Both serum lactate and ScvO2 following reperfusion in the non-IPGF group were markedly lower than that in the IPGF group (53.46±13.62 mg/dl Vs 82.02±14.16mg/dl, p <0.001) and (79.89±15.79 % Vs 90 ±12.08 % p<0.001) respectively. Serum lactate was positively correlated with peak level of ALT, AST, INR and serum bilirubin at r= 0.19, 0.34, 0.44, and 0.30 (p=0.23, 0.03, <0.001, and 0.05) respectively. ScvO2 was also positively correlated with the same values at r=0.34, 0.48, 0.22, and 0.19 (P=0.03, <0.001, 0.17, and 0.22) respectively. ScvO2 and serum lactate measures were found to be highly correlated at r= 0.41 (p<0.001). Receiver operating
characteristics curve (ROC) analysis resulted in an area under the curve of 0.65 for serum lactate and 0.46 for ScvO2, with a sensitivity and specificity of 83 % and 50 % for serum lactate, and 94% and 25 % for ScvO2. The optimum cut-off values for lactate and ScvO2 predicting IPGF were 31.55% and 66.5 respectively. Conclusions: Both change in intraoperative blood lactate and ScvO2 after hepatic allograft reperfusion served as good predictor of initial graft function during LT.