Noninvasive evaluation of cytochrome c oxidase activity of the liver. Its prognostic value for hepatic resection

J. Ueda, K. Mori, Y. Sakai, A. Tanaka, T. Katayama, A. Maki, Y. Shimahara, Y. Yamaoka and K. Ozawa
Second Department of Surgery, Kyoto University Faculty of Medicine, Japan.

OBJECTIVE: To clarify the relationship between the noninvasive evaluation of hepatic mitochondrial function, the redox tolerance test, and cytochrome c oxidase activity of the liver, focusing on surgical risk in hepatic resection. DESIGN: Six-month randomized clinical trial. SETTING: Inpatients in surgical department. STUDY PARTICIPANTS: Forty patients who underwent hepatic resection (n = 36) and other abdominal operations (n = 4). INTERVENTION: Preoperative, noninvasive: The redox tolerance test, which measures the changes in arterial ketone body ratio in response to 75 g of oral glucose loading. Intraoperative, invasive: Cytochrome c oxidase activity and energy charge of the liver. MAIN OUTCOME MEASURE: Correlation of the index in the redox tolerance test (RTI) with cytochrome c oxidase activity, both of which predict the postoperative course. RESULTS: The RTI values were negatively correlated with the maximal velocity (Vmax) and Michaelis constant (Km) values of cytochrome c oxidase activity. The maximal velocity and Michaelis constant values in patients with RTI values above or equal to 0.5 (group A, n = 29) were significantly lower than those in patients with RTI values below 0.5 (group B, n = 11). Eight (72.7%) of 11 patients in group B experienced postoperative complications. CONCLUSION: The RTI is a noninvasive method of assessing the hepatic energy metabolism and can be a useful index for evaluating surgical risk in hepatectomy.