ARTERIAL KETONE-BODY RATIO DURING HEPATECTOMY

The arterial ketone body ratio (AKBR) has been proposed as an accurate indicator of liver mitochondrial redox potential. However, the effica cy of the AKBR as a biochemical marker has been recently called into q uestion. To resolve this issue, we studied the effect of temporary vas cular occlusion on the AKBR during hepatectomy. Twenty patients underg oing hepatectomy were divided into two groups: those with hepatocellul ar carcinoma with a history of hepatic cirrhosis (n=10; cirrhotic grou p) and those with liver disease without cirrhosis (n=10; non-cirrhotic group). To minimize blood loss during hepatectomy, temporary vascular occlusion was applied using the Pringle maneuver. Acetoacetate and be ta-hydroxybutyrate concentrations in the arterial blood and the AKBR w ere determined before and after vascular occlusion. In 25% of the two groups combined, the AKBR increased following normothermic ischemia, a s compared with the levels prior to clamping; in 20% of cases in, the cirrhotic group, it increased immediately following reperfusion, as co mpared with the levels prior to clamping. Changes in the AKBR during h epatectomy did not correlate with preoperative hepatocellular function . An AKBR of less than 0.7 prior to clamping which persisted during su rgery was not a consistent risk factor for postoperative complications . The AKBR was not a useful predictor of liver viability in partial li ver resection with temporary vascular occlusion.