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Am J Physiol Gastrointest Liver Physiol (August 23, 2007). doi:10.1152/ajpgi.00366.2006
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Submitted on August 6, 2006
Accepted on August 12, 2007

The effect of major liver resection on hepatic ureagenesis in man

Marcel CG van de Poll1*, Stephen J Wigmore2, Doris N Redhead3, Regina GH Beets-Tan4, O James Garden2, Jan-Willem M Greve1, Peter B. Soeters5, Nicolaas E.P. Deutz5, Kenneth C.H. Fearon6, and Cornelis H.C. Dejong7

1 Department of Surgery, University Hospital Maastricht, Maastricht, Netherlands; Nutrition and Toxicology Research Institute Maastricht, Maastricht University, Maastricht, Netherlands
2 Clinical and Surgical Sciences (Surgery), Royal Infirmary, Edinburgh, United Kingdom
3 Department of Radiology, Royal Infirmary, Edinburgh, United Kingdom
4 Department of Radiology, University Hospital Maastricht, Maastricht, Netherlands
5 Department of Surgery, University Hospital Maastricht, Maastricht, Netherlands; Nutrition and Toxicology Research Institute Maastricht (NUTRIM), Maastricht University, Maastricht, Netherlands
6 Royal Infirmary of Edinburgh, Lauriston Place, Edinburgh EH2 9VW, United States; Clinical and Surgical Sciences (Surgery), Royal Infirmary, Edinburgh, United States
7 Surgery, University Hospital Maastricht, PO Box 5800, Maastricht, 6202 AZ, Netherlands; Department of Surgery, University Hospital Maastricht, Maastricht, Netherlands; Maastricht, Netherlands; Nutrition and Toxicology Research Institute Maastricht (NUTRIM), Maastricht University, Maastricht, Netherlands; Clinical and Surgical Sciences (Surgery), Royal Infirmary, Edinburgh, United States

* To whom correspondence should be addressed. E-mail: mcg.vandepoll{at}ah.unimaas.nl.

Changes in hepatic ureagenesis following major hepatectomy are not well characterized. We studied the relation between urea synthesis and liver mass before and after major hepatectomy in man. Fifteen patients scheduled for resection of malignancies in otherwise healthy livers were studied. Pre- and postoperative liver volume was assessed by CT-volumetry. During surgery, a primed, continuous infusion of [13C]-urea was administered intravenously and arterial blood samples were obtained hourly. ICG clearance was determined before and after resection. Seven patients underwent major hepatectomy, 8 patients underwent minor (<5% functional liver volume (total volume minus tumour volume)) or no resection, serving as controls. Resected functional liver volume in the major hepatectomy group averaged 60%. Urea synthesis per gram of functional liver tissue increased 2.6-fold following major hepatectomy maintaining whole body urea synthesis. Arterial ammonia remained unchanged throughout the study whereas following hepatectomy a hyperaminoacidemia occurred. In conclusion, immediately following major hepatectomy, urea synthesis per gram of functional liver tissue increases rapidly and proportionately to the amount of liver tissue resected, maintaining whole body urea synthesis at preoperative levels. This rapid and complete adaptation suggests that the capacity of urea synthesis is not limiting the maximum resectable volume in otherwise healthy livers.




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 Am. J. Physiol. Gastrointest. Liver Physiol.Home page
M. C. G. van de Poll, G. C. Ligthart-Melis, S. W. M. Olde Damink, P. A. M. van Leeuwen, R. G. H. Beets-Tan, N. E. P. Deutz, S. J. Wigmore, P. B. Soeters, and C. H. C. Dejong
The gut does not contribute to systemic ammonia release in humans without portosystemic shunting
Am J Physiol Gastrointest Liver Physiol, October 1, 2008; 295(4): G760 - G765.
[Abstract] [Full Text] [PDF]


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