title: N-acetylcysteine administration does not improve patient outcome after liver resection.
abstract: BACKGROUND
  Post-operative hepatic dysfunction is a major cause of concern when undertaking a liver resection. The generation of reactive oxygen species (ROS) as a result of hepatic ischaemia/reperfusion (I/R) injury can result in hepatocellular injury. Experimental evidence suggests that N-acetylcysteine may ameliorate ROS-mediated liver injury.
  
  
  METHODS
  A cohort of 44 patients who had undergone a liver resection and receiving peri-operative N-acetylcysteine (NAC) were compared with a further cohort of 44 patients who did not. Liver function tests were compared on post-operative days 1, 3 and 5. Peri-operative outcome data were retrieved from a prospectively maintained database within our unit.
  
  
  RESULTS
  Administration of NAC was associated with a prolonged prothrombin time on the third post-operative day (18.4 versus 16.4 s; P = 0.002). The incidence of grades B and C liver failure was lower in the NAC group although this difference did not reach statistical significance (6.9% versus 14%; P = 0.287). The overall complication rate was similar between groups (32% versus 25%; P = ns). There were two peri-operative deaths in the NAC group and one in the control group (P = NS).
  
  
  CONCLUSIONS
  In spite of promising experimental evidence, this study was not able to demonstrate any advantage in the routine administration of peri-operative NAC in patients undergoing a liver resection.
authors: Department of HPB & Transplant Surgery, Freeman Hospital, Newcastle upon Tyne, UK.
authors: Stuart M
authors: SM
authors: Robinson
authors: Rehan
authors: R
authors: Saif
authors: Gourab
authors: G
authors: Sen
authors: Jeremy J
authors: JJ
authors: French
authors: Bryon C
authors: BC
authors: Jaques
authors: Richard M
authors: RM
authors: Charnley
authors: Derek M
authors: DM
authors: Manas
authors: Steven A
authors: SA
authors: White
mesh_terms: D000111:Acetylcysteine / Q000008:administration & dosage*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D000975:Antioxidants / Q000008:administration & dosage*; D016009:Chi-Square Distribution; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects* / Q000401:mortality; D006801:Humans; D017093:Liver Failure / Q000209:etiology / Q000378:metabolism / Q000401:mortality / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D018384:Oxidative Stress / Q000187:drug effects; D015427:Reperfusion Injury / Q000209:etiology / Q000378:metabolism / Q000401:mortality / Q000517:prevention & control*; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000975:Antioxidants; D000111:Acetylcysteine