SAGES Magazine

Background: Post-hepatectomy liver failure (PHLF) is an important cause of morbidity and mortality following liver resection. Current prognostic models only allow for the detection of PHLF on post-operative day 5. Earlier detection and intervention may improve outcomes. To date, no studies have evaluated serial post-operative lactate and liver function tests (LFT) to predict PHLF. Aim: This study evaluated the prognostic utility of serial lactate concentrations and LFTs to predict PHLF following hepatectomy. Methods: All major liver resections (≥ 3 Couinaud segments) undertaken at Groote Schuur Hospital and UCT Private Academic Hospital from May 2018 to April 2021 were included. Lactate levels were measured 4-hourly for the first 24 hours post hepatectomy and daily LFTs for the first 5 days. Associations between baseline patient characteristics and lactate dynamics in PHLF as well as the predictive value of lactate, INR and bilirubin were determined. Results: Forty-seven patients, mean age 56.5 (±13.2) years, of whom 24 were males were assessed. Five (10.6%) patients had PHLF andwere older (67.4 ± 12.2) and were predominantly men (80%). The presence of diabetes was significantly associated with PHLF (b (SE) 2.97 (1.09), p =0.007) as were intra-abdominal collections (b (SE) 2.68 (1.18), p =0.023). In univariate analysis, lactate levels measured 16 hours post- operatively were marginally associated with PHLF (b (SE) 1.68 (0.85), p =0.054). In multivariate analyses where diabetes and collections were adjusted for, INR and total bilirubin were significantly associated with PHLF on day 3 (b (SE) 0.27 (0.11), p =0.022; and b (SE) 33.51 (12.05), p = 0.008 respectively). Conclusion: Lactate as marker for PHLF is promising but requires further investigation in a larger sample size. Diabetes is associated with the development of PHLF and should be considered as a pre-operative risk factor, while INR and bilirubin diagnosed PHLF on Day 3. A prospective observational study investigating the kinetics of routine liver function tests and arterial lactate concentrations after hepatectomy and their relationship to the development of postoperative liver failure V Soldati, MM Bernon, JEJ Krige, UK Kotze, JC Kloppers, S Burmeister, M Mercouris, EG Jones Department of Surgery, University of Cape Town Health Sciences Faculty, Surgical Gastroenterology and HPB Unit, Groote Schuur Hospital SAGES Saturday 16 October Radisson Blu Gautrain Hotel, Sandton, Gauteng 08:30 – 13:00 Prof Rupert Leong, Clinical Professor of Medicine at University of Sydney, UNSW and Macquarie University, Sydney Australia • Endoscopy and Crohn’s Disease • An overview of stomas and the IBD patient • Oral targeted IBD therapies in 2021 • Case presentations RSVP: Cornucopia Communications bini@global.co.za Queries : Bini Seale 0824429779 CPD Accredited COVID-friendly venue with virtual option INFLAMMATORY BOWEL DISEASE INTEREST GROUP www.gastrofoundation.co.za