{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,3,30]],"date-time":"2025-03-30T04:16:09Z","timestamp":1743308169664,"version":"3.40.3"},"reference-count":50,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"7","license":[{"start":{"date-parts":[[2015,9,1]],"date-time":"2015-09-01T00:00:00Z","timestamp":1441065600000},"content-version":"tdm","delay-in-days":2618,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2008,7]]},"abstract":"<jats:sec>\n            <jats:title\/>\n            <jats:p>Lactic acidosis occurs during orthotopic liver transplantation (OLT), especially during the anhepatic and early postreperfusion phases. Dichloroacetate (DCA) inhibits pyruvate dehydrogenase kinase-1, indirectly activating mitochondrial pyruvate dehydrogenase. This, in turn, markedly reduces systemic lactate production and, to a lesser extent, increases hepatic lactate uptake. The result is moderation of lactic acidosis in many clinical conditions. This study evaluated the efficacy of DCA in controlling lactic acidosis during OLT and improving perioperative outcome from OLT. After informed consent, 250 patients for OLT received either intraoperative DCA or placebo. DCA (40 mg\/kg intravenously) or placebo was administered after anesthesia induction and repeated 4 hours later. Intraoperative measures were arterial blood gases, lactate, and Na<jats:sup>+<\/jats:sup> and utilization of blood products, CaCl<jats:sub>2<\/jats:sub>, and NaHCO<jats:sub>3<\/jats:sub>. Outcome measures were time to tracheal extubation, intensive care unit length of stay, hospital length of stay, requirement for postoperative plasma transfusion, retransplantation, and perioperative mortality. DCA reduced the arterial lactic acid concentration by an average of 44% (1.8 mmol L<jats:sup>\u22121<\/jats:sup>, <jats:italic toggle=\"yes\">P<\/jats:italic> &lt; 0.001), stabilized the acid-base balance, and reduced NaHCO<jats:sub>3<\/jats:sub> administration by 80% (<jats:italic toggle=\"yes\">P<\/jats:italic> &lt; 0.001). Postoperatively, DCA-treated patients required 50% less postoperative plasma transfusion (2 versus 4 units, respectively, <jats:italic toggle=\"yes\">P<\/jats:italic> = 0.016), but the incidence of transfusion was similar in both groups (62% versus 60%, <jats:italic toggle=\"yes\">P<\/jats:italic> = 0.381). DCA did not alter time to extubation, intensive care unit length of stay, or hospital length of stay. In conclusion, DCA attenuated lactic acidosis during OLT, stabilizing the intraoperative acid-base balance and decreasing NaHCO<jats:sub>3<\/jats:sub> use. DCA decreased postoperative plasma transfusion requirement but otherwise had no measurable effect on perioperative outcome parameters. Liver Transpl 14:989\u2013998, 2008. \u00a9 2008 AASLD.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1002\/lt.21485","type":"journal-article","created":{"date-parts":[[2008,6,25]],"date-time":"2008-06-25T19:47:57Z","timestamp":1214423277000},"page":"989-998","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":6,"title":["Dichloroacetate stabilizes the intraoperative acid-base balance during liver transplantation"],"prefix":"10.1097","volume":"14","author":[{"given":"Robert E.","family":"Shangraw","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Deirdre","family":"Lohan-Mannion","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Agnes","family":"Hayes","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rose M.","family":"Moriarty","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rongwei","family":"Fu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephen T.","family":"Robinson","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","reference":[{"key":"R1-13-20250326","first-page":"F630","article-title":"Metabolic effects of sodium bicarbonate in hypoxic lactic acidosis in dogs.","volume":"249","author":"Graf","year":"1985","journal-title":"Am J Physiol"},{"key":"R2-13-20250326","doi-asserted-by":"crossref","first-page":"1243","DOI":"10.1016\/0140-6736(90)91305-T","article-title":"Paradoxical effect of bicarbonate on cytoplasmic pH.","volume":"335","author":"Ritter","year":"1990","journal-title":"Lancet"},{"key":"R3-13-20250326","doi-asserted-by":"crossref","first-page":"559","DOI":"10.1042\/cs0820559","article-title":"Effect of bicarbonate administration on skeletal muscle intracellular pH in the rat: implications for acute administration of bicarbonate in man.","volume":"82","author":"Thompson","year":"1992","journal-title":"Clin Sci (Lond)"},{"key":"R4-13-20250326","first-page":"H1572","article-title":"Lactic acidosis: effect of treatment on intracellular pH and energetics in living rat heart.","volume":"262","author":"Zahler","year":"1992","journal-title":"Am J Physiol"},{"key":"R5-13-20250326","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1016\/S0002-9343(89)80475-9","article-title":"Effect of bicarbonate administration on cardiac function.","volume":"87","author":"Ayus","year":"1989","journal-title":"Am J Med"},{"key":"R6-13-20250326","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1016\/S0002-9343(89)80476-0","article-title":"Metabolic and hemodynamic consequences of sodium bicarbonate administration in patients with heart disease.","volume":"87","author":"Bersin","year":"1989","journal-title":"Am J Med"},{"key":"R7-13-20250326","doi-asserted-by":"crossref","first-page":"379","DOI":"10.1002\/dmr.5610050405","article-title":"Regulation of lactate metabolism in vivo.","volume":"5","author":"Buchalter","year":"1989","journal-title":"Diabetes Metab Rev"},{"key":"R8-13-20250326","first-page":"E504","article-title":"Metabolic and thermogenic effects of lactate infusion in humans.","volume":"265","author":"Ferrannini","year":"1993","journal-title":"Am J Physiol"},{"key":"R9-13-20250326","doi-asserted-by":"crossref","first-page":"1100","DOI":"10.1056\/NEJM198011063031907","article-title":"Stimulation of lactate production by administration of bicarbonate in a patient with a solid neoplasm and lactic acidosis.","volume":"303","author":"Fraley","year":"1980","journal-title":"N Engl J Med"},{"key":"R10-13-20250326","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1111\/j.1399-0012.1998.tb01102.x","article-title":"Liver transplantation in hyponatremic patients with emphasis on central pontine myelinolysis.","volume":"12","author":"Abbasoglu","year":"1998","journal-title":"Clin Transplant"},{"key":"R11-13-20250326","doi-asserted-by":"crossref","first-page":"493","DOI":"10.1212\/WNL.39.4.493","article-title":"Central pontine myelinolysis after liver transplantation.","volume":"39","author":"Estol","year":"1989","journal-title":"Neurology"},{"key":"R12-13-20250326","doi-asserted-by":"crossref","first-page":"1006","DOI":"10.1097\/00007890-198912000-00023","article-title":"Pontine and extrapontine myelinolysis following liver transplantation. 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