Liver Transplantation
Conditions
Brief summary
Lactic acidosis is a common phenomenon occurring during orthotopic liver transplantation (OLT), especially during the anhepatic and early postreperfusion phases. However, little drugs effectively decrease the degree of lactic acidosis when it happens. The aim of this study is to explore whether glucose-Insulin-Potassium(GIK) infusion can relieve metabolic acidosis and improve perioperative outcome in patients undergoing OLT.
Detailed description
Intraoperative metabolic acidosis begins soon after graft reperfusion and persists for several days. The current standard treatment for severe acidosis during OLT is NaHCO3, although it may compromise myocardial performance, exacerbate lactic acid accumulation and cause central nervous system demyelination. Surgical procedure is a primary source of endogenous lactic acid production, especially visceral ischemia originating from anhepatic stage. The present study thus hypothesized that GIK solution may improve metabolic acidosis in OLT patients through its unique effects of metabolic alleviation. Patients for orthotopic liver transplantation was enrolled and received either GIK or placebo. GIK or placebo infusion started after anesthesia induction. Intraoperative measures were mean arterial pressure, HR, arterial blood gases, lactate, glucose, Na, liver and renal function indexes. Outcome measures were time to tracheal extubation, intensive care unit, length of stay, complications, hospital length of stay, requirement for postoperative plasma transfusion, retransplantation, and perioperative mortality.
Interventions
OTHERsaline
saline
OTHERInsulin
Sponsors
Central South University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
TRIPLE (Subject, Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Healthy volunteers
No
Inclusion criteria
* patients who were to undergo OLT
Exclusion criteria
* diabetes mellitus, hyperkalemia on arrival (K+ \> 5.5 mEq/L) and the inability to give informed consent
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| degree of lactic acidosis | up to 1 weeks | Blood samples for arterial blood pH, PCO2 , PO2 , base excess, hematocrit, and plasma concentrations of lactic acid and Na were analyzed |
Other
| Measure | Time frame | Description |
|---|---|---|
| tracheal extubation | up to 3 days | The time of tracheal extubation was calculated. |
| intensive care unit length of stay and hospital length of stay | up to 1 month | The intensive care unit length of stay and hospital length of stay was calculated |
| The incidence of complications | up to 1 month | The incidence of complications including liver dysfunction, renal dysfunction, infection, was analyzed |
| The incidence of retransplantation | up to 1 month | The incidence of liver retransplantation |
| The incidence of perioperative mortality | up to 1 month | The incidence of perioperative mortality |
Countries
China
Outcome results
None listed