Abstracts
2000 Digestive Disease Week

# 2280 The Hippurate Ratio as an Indicator of Hepatic Reserve in Cirrhotics Undergoing Liver Resection.
Alan W. Hemming, Juan R. Sanabria, Paul D. Greig, Steven Gallinger, Bernard Langer, Bryce R. Taylor, Katryn Furuya, Gainesville, FL, Toronto, ON, Canada

Predicting the ability of the cirrhotic liver to withstand hepatic resection remains a difficult challenge for the surgeon. This study evaluates the use of the hippurate ratio, a novel assessment of glycine conjugation of paraamino benzoic acid by the liver, as a preoperative indicator of functional hepatic reserve. Between 1996 and 1999, fifty-five cirrhotic patients were prospectively assessed prior to hepatic resection using the hippurate ratio, indocyanine green retention at 15 minutes (ICG R-15) and other standard measures of liver function. Twenty-four patients were excluded as candidates for resection based on hepatocellular reserve that was estimated to be inadequate for the size of resection contemplated. Patients excluded from resection had significantly higher ICG R-15 values (29%: 95% C.I. 24-34% vs 16%: 95% C.I. 13-20%, P=0.001), higher Child-Pugh scores ( 5.8:95% C.I. 5.4-6.2 vs 5.3:95% C.I. 5.1-5.5 p=0.03) and lower hippurate ratios(31%: 95% C.I. 21-40% vs 45%: 95% CI 38-51%, p=0.01). There was a significant correlation between the hippurate ratio and ICG R-15.Other indicators of liver function such as Factor V, Factor VII, albumin, bilirubin, PT, and transaminases were no different between patients resected and not resected. Of the 31 patients that were resected there were 6 patients(19%) that developed varying degrees of liver failure with 2 post operative deaths(6%). Patients that developed some degree of liver failure had significantly lower hippurate ratios than patients that developed no liver failure (29%: 95% C.I. 17-40% vs 48% : 95% C.I. 42-54%, p= 0.01). There was no difference in ICG R-15 values between patients that developed liver failure and those that did not. The hippurate ratio offers information on hepatocellular reserve that is not provided by other measures of liver function and may allow better selection of patients with cirrhosis that will tolerate hepatic resection.