AIM:To evaluate hepatic energy charge levels of the patients with hepatoma after hepatic artery embolization and its relation to postoperative complications.METHODS:Sixty-nine patients with hepatoma were continuously measured for their arterial blood ketone body ratio (AKBR) and compared with their postoperative clinical course or conventional liver function test after various hepatic artery embolization.RESULTS:AKBR in high radiation dose or jaundice group drastically decreased at 1-3 days and recovered slowly. Patients were classified into three groups according to the value of AKBR: group A (35 cases), AKBR remained higher than 0.7; group B (31 cases), AKBR had transiently dropped to 0.4-0.7 and then increased to preoperative value; and group C (3 cases), AKBR decreased steadily to below 0.4.The occurrence rate of various complications were 5.7%, 32.3% and 100% in the three groups, respectively (P < 0.005).CONCLUSION:The AKBR which reflects hepatic mitochondria redox state is more reliable as a direct indicator to assess hepatic tolerance for embolization than routine liver function test.