Correlation of hepatic injury, synthetic function, and mitochondria energy level in orthotopic liver transplantation

The arterial ketone blood ratio (AKBR) of acetoacetate to b-hydroxybutyrate was previously shown to reflect hepatic mitochondria oxidation/reduction (redox) state and energy level. In this study we correlated AKBR to the degree of liver injury immediately following orthotopic liver transplantation (OLT). Serial measurements of AKBR in 209 patients undergoing OLT, during the anhepatic phase, and up to 60 hr following reperfusion demonstrated direct correlation between mitochondria Redox state (AKBR), hepatocyte injury (SGOT), and hepatic synthetic function (prothrombin time). AKBR levels <0.7 were seen in primary nonfunction grafts and were associated with raising SGOT (>1000) and prolonged PT (>18). Acute occlusion of arterial blood supply to the graft was seen in conjunction with low AKBR (<0.7). However, hepatic synthetic function and serum enzyme were stabilized or returned to normal within 24-48 hr postreperfusion. In conclusion: (1) AKBR measurements are useful in predicting graft survival, (2) reduction in liver mitochondria Redox state is seen in primary hepatocyte dysfunction and correlates well to synthetic function, and (3) acute occlusion of the arterial supply to the liver graft is associated with decreased redox state. However, with intact portal blood flow, it is still possible to preserve adequate hepatic synthetic function.