Contribution of donor factors to post-reperfusion severe hyperglycemia in patients undergoing living donor liver transplantation.

Abstract

Blood glucose levels increase abruptly after graft reperfusion during living donor liver transplantation (LDLT), but studies on perioperative factors contributing to this phenomenon are rare. We developed a predictive model for post-reperfusion severe hyperglycemia (PRSH) based on donor-related factors. Preoperative and intraoperative recipient data, as well as donor data, on 279 LDLT cases were reviewed. The mean blood glucose levels at each LDLT surgical phase were calculated, and patients were divided into PRSH and non-PRSH groups using a cutoff of 230 mg/dL mean blood glucose level during the neo-hepatic phase. Perioperative variables were compared between the 2 groups, and selected variables were subjected to multivariate logistic regression to establish a predictive model for PRSH. There were 128 patients (45.9%) who developed PRSH, which was associated with preoperative diabetes mellitus but not with model for end-stage liver disease or Child-Pugh-Turcotte score. Intraoperatively, the PRSH group required more blood transfusions and experienced more circulatory insufficiency than did the non-PRSH group. PRSH patients received grafts with higher-level fatty changes and greater graft-to-recipient ratios (GRWRs) (both p<0.05). The multivariate predictive model included GRWR, graft fatty change ≥10% (OR 3.53), post-reperfusion syndrome ≥5 min in duration (OR 5.68), and recipient diabetes mellitus (OR 2.92) as independent risk factors. The risk of PRSH was proportional to the rise in GRWR. PRSH development was heavily influenced by donor-related factors. Graft size, extent of fatty change, and post-reperfusion syndrome were identified as independent donor-associated predictors of PRSH.