[Metabolic liver support for hepatectomized patients]

Thirty-nine patients with hepatic resection were classified into 3 groups according to the postoperative changes in the blood ketone body ratio. (A) In 19 patients, the blood ketone body ratio did not decrease to below 0.7. These patients had an uneventful clinical course. (B) In 14 patients, the blood ketone body ratio remained 0.4-0.7 in the first several days. Seven patients suffered from serious complications. However, those complications were ameliorated as the blood ketone body ratio rose subsequently. (C) Six patients, whose blood ketone body ratio showed irreversible decreases, had formidable complications. Finally, they died of multiple organ failure. The metabolic liver support designed by us (an ex vivo pig or baboon liver cross-hemodialysis with an interposed cuprophan membrane) has been applied for the patients with both blood ketone body ratio below 0.4 and grade IV hepatic coma. All 3 patients who had blood ketone body ratios of 0.4-0.25 became fully alert after liver support concomitant with the restoration of the blood ketone body ratio. By contrast, in 3 patients with blood ketone body ratio below 0.25, there was no restoration of consciousness ans no improvement in their blood ketone body ratios by this liver support. Consequently, a marked decrease of the blood ketone body ratio due to hepatic failure predicts a fatal outcome.