RESPONSE OF HEPATIC MITOCHONDRIAL REDOX STATE TO ORAL GLUCOSE-LOAD - REDOX TOLERANCE-TEST AS A NEW PREDICTOR OF SURGICAL RISK IN HEPATECTOMY

The redox tolerance test introduced in this article attempts to quantify the deterioration of hepatic mitochondrial energy metabolism by measuring the changes in arterial ketone body ratio in response to 75-g oral glucose loading, and is discussed in relation to its predictive value for assessing surgical risk in hepatectomy. The indicator, called redox tolerance index (RTI), represents a 100-fold cumulative enhancement of ketone body ratio relative to glucose level (100 × ΔKBR/Δ glucose). The redox telerance index was significantly different between 31 liver cirrhotics and 10 normal volunteers (p < 0.001). Subjects were divided into three classes (I: RTI ≥ 1.0, II: 0.5 ≤ RTI < 1.0, III: RTI < 0.5). Postoperative mortality was significantly different among the three classes in 127 hepatic resections (x2 = 9.843, p < 0.01). Of 97 hepatocellular carcinoma cases, major hepatic resections in class III showed significantly higher post-operative morbidity and mortality rates (p < 0.05 and p < 0.05, respectively). The present findings indicate that RTI based on redox theory is of potential value in predicting posthepatectomy outcome.