Impact of N-acetylcysteine on Liver Failure after Hepatectomy

Shunji Kawamoto, Masami Kimura^* and Shigenori Sugihara^**

Department of Surgery, Fukuoka Tokushukai Medical Center,
^*Department of Surgery, Health Insurance Hitoyoshi General Hospital,
^**Department of Surgery, Shimonoseki Welfare Social Hospital

The prognosis of liver failure after liver resection is poor. We administerd N-acetylcysteine (NAC), a precursor of glutathione synthesis in the liver, for such patients, with favorable results. Case 1: A 73-year-old man undergoing caudate lobectomy with bile duct resection due to hepatic hilar carcinoma suffered liver failure with 7.4 mg/dl of total birilubin in serum (T-bil). NAC administration at a total dose of 66.88g per os during 3 days decreased T-bil by 5.3mg/dl in 4 days and the patient remains alive and tumor-free. Case 2: A 65-year-old man with liver failure after partial liver resection due to gallbaldder cancer was treated with NAC after an increase in T-bil of 10.2mg/dl. The patient remains tumor-free. Case 3: A 68-year old man with liver failure after right liver lobectomy due to hepatocellular carcinoma underwent plasma exchange and dialysis for bilirubin absorption, but without effect. NAC administeration improved T-bil of 10.3 mg/dl and 35% hepaplastin test to 5.2 mg/dl or 57%. The patient is alive without recurrence. We discuss our experience with NAC treatment for liver failure after liver resection.

Key words
N-acetylcysteine, glutathione, liver failure

Reprint requests
Shunji Kawamoto Department of Surgery, Fukuoka Tokushukai Medical Center Sukukita 4-5, Kasuga, 816-0864 JAPAN

Accepted
June 25, 2002

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