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Elevation of Asymmetric Dimethylarginine (ADMA) in Patients Developing Hepatic Failure After Major Hepatectomy

Robert J. Nijveldt, MD^*, Tom Teerlink, PhD, Michiel P. C. Siroen, MD^*, Ben van der Hoven, MD, Hubert A. Prins, MD, PhD^*, Marinus J. Wiezer, MD, PhD^*, Catharina Meijer, MD, PhD^*, Joost R. M. van der Sijp, MD, PhD^*, Miguel A. Cuesta, MD, PhD^*, Sybren Meijer, MD, PhD^* and Paul A. M. van Leeuwen, MD, PhD^*

From the ^* Departments of Surgery and Clinical Chemistry, VU University Medical Center, Amsterdam; and Department of Surgical Intensive Care, Erasmus University Medical Center, Rotterdam, The Netherlands

Correspondence: Paul A. M. van Leeuwen, MD, PhD, VU University Medical Center, Department of Surgery, PO Box 7057, 1007 MB Amsterdam, The Netherlands. Electronic mail may be sent to pam.vleeuwen{at}vumc.nl or rj.nijveldt{at}vumc.nl.

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.

Journal of Parenteral and Enteral Nutrition, Vol. 28, No. 6, 382-387 (2004)
DOI: 10.1177/0148607104028006382


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