The effect of nutrition status and arginin on liver hypertrophy after portal vein embolization

Background/Purpose:

In patients with various kinds of liver tumors resection is the only treatment method, which can provide long term survival. If the residual liver (future liver remnant-FLR) after the planned resection is less than 30–40% (normal liver-cirrhosis) of the total liver, portal vein occlusion of the tumorous liver lobe can hypertrophise the contralateral lobe. A key step in this process is nitrogen monoxide (NO), which origins from L-arginine through NO synthase. The effect of nutritional status, body composition and arginine supplementation of normal feeding on the liver hypertrophy after portal vein occlusion was investigated.

Patients/Methods: Consecutive patients with liver tumors, whose remnant liver after the planned liver resection were less than 30, or 40% of the total liver volume, measured by CT-volumetry were enrolled in our study (from 2010 November- March 2012). In addition to the traditional anthropometric (BMI) and laboratory (prealbumin, albumin, lymphocyte count, etc.) tests, bioimpedance analysis (multi-frequency device, measured parameters: extra-, intracellular water ratio, illness marker, phase angle) was also performed to asses nutritional status and body composition. Patients randomized in the arginine group received 2×200ml (2×250kcal) oral nutritional supplement (ONS), contains 2×3g arginine for the 8 weeks period of liver hypertrophy. Patients in the control group were supplemeted with an ONS without arginine, but with the same calorie and content. Eight weeks after portal vein occlusion control CT-volumetry, repeated anthropometry, bioimpedance analysis, and laboratory tests were performed to determine nutritional status and body composition again.

Results: In the group of arginine supplementation liver hypertrophy rate was higher (FLRArg: 13.54% vs. FLRc: 10.64%). Among laboratory parameters -indicating nutritional status- lymphocyte count and albumin levels changes were significantly higher in the arginine group than in the control group (LymphArg: LymphC 10.1% vs. 0.7%; AlbArg: 2.4 vs. AlbC: -3.9%, p<0.05). Patients with higher illness marker (IM r=0.79) and lower phase angle (PA r=0.75), the rates of irresecability and postoperative complications were also higher (p<0.05).

Conclusion: The nutritional status and arginine supplementation positively affects the liver hypertrophy after portal vein occlusion.