HIGH PREOPERATIVE SERUM ALANINE TRANSFERASE LEVELS - EFFECT ON THE RISK OF LIVER RESECTION IN CHILD GRADE A CIRRHOTIC-PATIENTS

Despite careful selection of cirrhotic patients with hepatocellular ca rcinoma (HCC), liver resection remains associated with a greater risk than in patients without underlying liver disease. In this study we as sessed by multivariate analysis parameters associated with in-hospital mortality and morbidity in a selected group of 108 Childs-Pugh A cirr hotic patients undergoing liver resection of HCC. The overall incidenc es of in-hospital deaths and postoperative complications were 8.3% and 48.1%, respectively. By univariate analysis, the preoperative serum a lanine transferase (ALT) level (p = 0.001) and intraoperative transfus ions (p = 0.01) were significantly associated with in-hospital death; however, only the serum ALT concentration was an independent risk fact or. In-hospital mortality rates in patients whose serum ALT was below 2N (twofold the upper limit of the normal value), between 2N and 4N, a nd more than 4N were 3.9%, 13.0%, and 37.5%, respectively. An ALT leve l greater than 2N was predominantly observed in patients with a hepati tis C virus infection and significantly associated with histologic fea tures of superimposed active hepatitis. Patients with an ALT level gre ater than 2N experienced an increased incidence of postoperative ascit es (58% versus 32%, p = 0.01), kidney failure (16% versus 0%, p = 0.00 03), and upper gastrointestinal bleeding (6.4% versus 0%, p = 0.02). T hese results indicate that the preoperative ALT level is a reliable pr edictor of in-hospital mortality and morbidity following liver resecti on in Child-Pugh A cirrhotic patients. Cirrhotic patients with ALT > 2 N should undergo only a limited resection; if a larger resection is re quired, those patients should be considered for nonsurgical therapy or liver transplantation.