Major liver resection results in a changed plasma amino acid pattern as reflected by a decreased Fischer ratio which improves by bactericidal/permeability increasing protein

Background/Aims: Major liver resection results in a high morbidity and mort ality, and endotoxin plays a role in post-resection hepatic failure. Severe hepatic failure as seen in hepatitis and cirrhosis may be accompanied by h epatic encephalopathy and is characterized by a typical plasma amino acid p attern reflected by a decreased Fischer ratio. This study was performed to evaluate the plasma amino acid pattern in patients undergoing major liver s urgery receiving placebo or the endotoxin-neutralizing agent bactericidal/p ermeability-increasing protein (rBPI(21)) Patients and methods: Forty-eight patients were randomized in this phase II, dose escalation, multicenter tr ial. Plasma amino acid profiles were determined preoperatively, and on the first (day 1) and third (day 3) postoperative day. Results. In the placebo group the Fischer ratio decreased significantly on both postoperative days. Administration of rBPI(21) also resulted in a decreased Fischer ratio on d ay 1, but not on day 3. Highly elevated alanine plasma levels were observed on day 1 in placebo-treated patients, whereas rBPI21 prevented this elevat ion. Plasma alanine levels on day 1 correlated with the duration of post-re section hepatic failure. Conclusions: Major liver resection results in a de creased Fischer ratio and a rise in plasma alanine levels. Plasma levels of alanine on the first postoperative day correlated with the duration of the post-resection hepatic failure. rBPI(21) improved the Fischer ratio and pr evented the rise of plasma alanine levels.