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Elevation of Asymmetric Dimethylarginine (ADMA) in Patients Developing Hepatic Failure After Major Hepatectomy
Author(s) -
Nijveldt Robert J.,
Teerlink Tom,
Siroen Michiel P. C.,
Hoven Ben,
Prins Hubert A.,
Wiezer Marinus J.,
Meijer Catharina,
Sijp Joost R. M.,
Cuesta Miguel A.,
Meijer Sybren,
Leeuwen Paul A. M.
Publication year - 2004
Publication title -
journal of parenteral and enteral nutrition
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.935
H-Index - 98
eISSN - 1941-2444
pISSN - 0148-6071
DOI - 10.1177/0148607104028006382
Subject(s) - asymmetric dimethylarginine , medicine , endocrinology , hepatectomy , nitric oxide , bilirubin , gastroenterology , liver function , liver function tests , excretion , arginine , resection , surgery , chemistry , biochemistry , amino acid
Background: Asymmetric dimethylarginine (ADMA) is an endogenous inhibitor of the arginine–nitric oxide pathway. It is conceivable that its concentration is tightly regulated by urinary excretion and degradation by the enzyme dimethylarginine dimethylaminohydrolase, which is highly expressed in the liver. In rats, we showed a high net hepatic uptake of ADMA. Therefore, we aimed to confirm the role of the liver in humans and hypothesized elevated ADMA levels after major liver resection by a reduction of functional liver mass and injury to the remnant liver. Methods: Patients undergoing a major hepatic resection (HEP, n = 17) or major abdominal surgery (MAS, n = 12) were included and followed in time. In addition, ADMA levels were measured in 4 patients having severe hepatic failure after a liver resection. Plasma ADMA concentration was measured by high‐performance liquid chromatography. Results: Preoperatively and on days 1, 3, and 5, plasma levels of ADMA were higher in HEP patients when compared with MAS patients. In HEP patients with prolonged (>7 days) hepatic injury, ADMA levels were especially elevated. On the first postoperative day, ADMA significantly correlated to bilirubin concentration ( r = .528, p < .05) as a marker of postoperative hepatic function. Besides, in patients with severe hepatic failure, ADMA levels were highly elevated. Conclusions: In the present study, evidence was found for the role of the liver in the elimination of ADMA in humans. Increased levels of ADMA occur in the postoperative course after a major hepatic resection, especially when liver function is severely impaired. Further studies need to assess the role of ADMA in the development of complications after liver surgery.