Effect of perioperative intensive insulin therapy for liver dysfunction after hepatic resection.

BACKGROUND

Intensive insulin therapy (IIT) reduces morbidity and mortality in patients in surgical care units, yet the benefits of IIT during liver surgery, especially on liver function after hepatic resection, are not known. The aim of the present study was to assess the effects of IIT, with a focus on postoperative liver function, in hepatectomized patients.

METHODS

A total of 150 patients who underwent surgical management for hepatic diseases between September 2007 and March 2009 at Kochi Medical School were investigated. Patients were divided into two groups: (1) those receiving IIT via a closed-loop glycemic control system (i.e., an artificial pancreas; AP group; n = 74); or (2) those receiving conventional insulin therapy using the sliding scale method (SS group; n = 76). The targeted blood glucose zones in the AP and SS groups were 80–110 and 150–200 mg/dl, respectively.

RESULTS

Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels increased and prothrombin time (%) decreased immediately after surgery in both groups. There was a significant difference in postoperative ALT levels between the two groups on postoperative days 1 and 6. Hepatocyte injury and changes in AST and ALT levels after surgery (compared with preoperative levels) were significantly greater in the SS group than AP group after liver resection. During the first 18 h after hepatic resection, 174 IU of insulin was required per patient for tight glycemic control with IIT.

CONCLUSIONS

Perioperative IIT ameliorated liver dysfunction after hepatic resection. Liver regeneration and/or an antiinflammatory effect of IIT may underlie its protective effects against hepatocyte injury in hepatectomized patients.