Effect of major hepatectomy on glucose and lactate metabolism

Background The liver plays an important role in glucose and lactate metabol ism. Major hepatectomy may therefore be suspected to cause alterations of g lucose and lactate homeostasis. Methods Thirteen subjects were studied: six patients after major hepatectom y and seven healthy subjects who had fasted overnight. Glucose turnover was measured with 6,6(2)H glucose. Lactate metabolism was assessed using two c omplementary approaches: C-13-glucose synthesis and (13)CO2 production from an exogenous C-13-labeled lactate load infused over 15 minutes were measur ed, then the plasma lactate concentrations observed over 185 minutes after lactate load were fitted using a biexponential model to calculate lactate c learance, endogenous production, and half-lives. Results Three to five liver segments were excised. Compared to healthy cont rols, the following results were observed in the patients: 1) normal endoge nous glucose production; 2) unchanged C-13-lactate oxidation and transforma tion into glucose; 3) similar basal plasma lactate concentration, lactate c learance, and lactate endogenous production; 4) decreased plasma lactate ha lf-life 1 and increased half-life 2. Conclusions Glucose and lactate metabolism are well maintained in patients after major hepatectomy, demonstrating a large liver functional reserve. Re duction in the size of normal liver parenchyma does not lead to hyperlactat emia. The use of a pharmacokinetic model, however, allows the detection of subtle alterations of lactate metabolism.