Prognostic significance of reperfusion hyperglycemia during liver transplantation

The liver occupies a central role in carbohydrate metabolism and glucose homeostasis. Consequently, significant changes in blood glucose levels can be anticipated in patients with end-stage liver disease undergoing orthotopic liver transplantation (OLT). Contrary to earlier reports, hypoglycemia during OLT has proven to be an uncommon problem: blood glucose levels generally remain within the range of 100-200 mg% even without dextrose infusion, owing to the administration of glucose in blood anticoagulated with citrate-phosphate-dextrose-adenine (CPDA-1), together with decreased glucose utilization secondary to anesthesia and inadvertent hypothermia. Hyperglycemia, however, is a consistent finding after reperfusion of the grafted liver. Blood glucose levels increase rapidly on reperfusion, slowly decreasing without treatment toward the end of the procedure. Postreperfusion hyperglycemia has also been seen in an animal model, and may be the result of a massive release of glucose from the donor liver presumed secondary to ischemic injury to the donor liver, which allows intracellular glucose to leak out of the hepatocytes. Therefore, the degree of hyperglycemia in the neohepatic stage may be a reflection of the ischemic insult sustained by the grafted liver. To determine the relation between the degree of reperfusion hyperglycemia and the functional recovery of the grafted liver, intraoperative glucose levels and subsequent liver function in adult patients undergoing OLT were studied retrospectively.