title: Perioperative treatment with bactericidal/permeability-increasing protein (rBPI21) in major liver surgery: a concise summary.
abstract: BACKGROUND
  Major hepatic resections are still associated with considerable morbidity. Gut-derived bacteria and bacterial endotoxin are considered to play a central role in the pathophysiology of complications. Experimental studies suggest that bactericidal/permeability-increasing protein (BPI), which has both antibacterial and endotoxin-neutralising properties, can reduce postoperative complications.
  
  
  METHODS
  A phase II, double-blind, placebo-controlled, multicentre, dose escalation trial was conducted in patients undergoing major liver resection, and clinical outcome, infectious complications, plasma amino acid patterns, coagulation and fibrinolytic cascade systems and neutrophil functions were compared between the two treatment groups and an extra group of patients undergoing major abdominal non-hepatic surgery.
  
  
  RESULTS
  Drug administration in this patient group was safe, and resulted in a significant reduction of infectious complications. Furthermore, beneficial effects were found in the postoperative amino acid ratio and fibrinolytic cascades, and rBPI21 preserved leukocyte functions.
  
  
  CONCLUSIONS
  Administration of rBPI21 in patients undergoing major liver resection is well tolerated and results in improvement of both clinical and biochemical parameters.
authors.affiliation: Department of Surgery, Vrije Universiteit Medical Centre, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands.
authors.forename: M J
authors.initials: MJ
authors.lastname: Wiezer
authors.forename: P G
authors.initials: PG
authors.lastname: Boelens
authors.forename: R J
authors.initials: RJ
authors.lastname: Vuylsteke
authors.forename: R J
authors.initials: RJ
authors.lastname: Nijveldt
authors.forename: C
authors.initials: C
authors.lastname: Meijer
authors.forename: M A
authors.initials: MA
authors.lastname: Cuesta
authors.forename: S
authors.initials: S
authors.lastname: Meijer
authors.forename: P A
authors.initials: PA
authors.lastname: van Leeuwen
mesh_terms: D000328:Adult; D000596:Amino Acids / Q000097:blood / Q000187:drug effects; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D023181:Antimicrobial Cationic Peptides; D001777:Blood Coagulation / Q000187:drug effects; D001798:Blood Proteins / Q000008:administration & dosage / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D006498:Hepatectomy / Q000009:adverse effects; D006801:Humans; D008099:Liver / Q000378:metabolism / Q000601:surgery*; D008565:Membrane Proteins; D009504:Neutrophils / Q000187:drug effects; D019990:Perioperative Care; D013530:Surgical Wound Infection / Q000097:blood / Q000188:drug therapy* / Q000517:prevention & control*; D016896:Treatment Outcome
chemical_list: D000596:Amino Acids; D000900:Anti-Bacterial Agents; D023181:Antimicrobial Cationic Peptides; D001798:Blood Proteins; D008565:Membrane Proteins; C021623:bactericidal permeability increasing protein