We investigated whether impaired Kupffer cell phagocytosis in fulminant hepatic failure could be due to reduced synthesis of hepatocyte-growth-factor-like/macrophage-stimulating protein (HGFL/MSP), a serum protein synthesised predominantly in hepatocytes and required by tissue macrophages for phagocytosis. Hepatic expression of the 3.0 kb HGFL/MSP mRNA, assessed by northern hybridisation, was lower in nine patients with fulminant hepatic failure undergoing liver transplantation than in three liver grafts as controls (median absorbance units 97 [range 15-1200] versus 1114 [1100-1120], respectively; p < 0.05). Decreased hepatic HGFL/MSP production might cause impaired Kupffer cell phagocytosis in fulminant hepatic failure.