Insulinopenia as a risk factor in hepatectomy and its resolution by intraportal insulin administration

Insulopenia is a possible risk factor in hepatectomy, especially since insulin has been recognized to have a significant hepatotrophic effect. In the current study, insulinopenic patients were defined as those who showed abnormally low insulinogenic indexes (less than 0.6) on the oral glucose tolerance test, compared with those in 22 normal volunteers (1.16 +/- 0.57, mean +/- SD). The insulinogenic index represents the ratio of the cumulative enhancement of immunoreactive insulin (IRI) to the glucose level (delta IRI/delta glucose). Surgical outcomes were studied retrospectively in 17 insulinopenic patients who underwent hepatic resections from January 1987 to July 1988. Six of 10 patients in the major hepatic resection group showed postoperative complications, 5 of whom experienced hepatic failure resulting in hospital death. By contrast, all seven patients in the minor resection group tolerated the operations. From August 1988, intraportal insulin was prospectively administered as a posthepatectomy management technique to nine patients, eight of whom were diagnosed as insulinopenic. These patients all tolerated major hepatic resections including four hepatic vascular exclusion procedures with veno-venous bypass. In conclusion, the current study indicates that insulinopenic patients are high-risk candidates for major hepatic resection and that intraportal insulin administration has a beneficial effect on the postoperative management of these patients.