Impairment of glucose homeostasis after hepatic ischemia

Abstract

An anticipated complication of surgery involving hepatic ischemia is disturbance of blood glucose regulation. Five cases of human orthotopic hepatic transplantation are discussed in regard to intraoperative and postoperative blood glucose changes. Fifty-five dogs were used to investigate the effect of experimental hepatic ischemia on glucose homeostasis. Glucose intolerance was reproducibly induced by as little as 20 minutes of normothermic stagnant ischemia or 30 minutes of hypothermic asanguinous perfusion ischemia. No abnormality of insulin response was noted after hepatic ischemia. Response to glucagon after hepatic ischemia was depressed. The duration and magnitude of net hepatic glucose uptake was diminished after hepatic ischemia. It is suggested that in addition to the recognized tendency to hypoglycemia after hepatic ischemia, there is also a tendency to hyperglycemia resulting from hypoxic depression of enzyme systems for hepatic glucose uptake.