Hepatic organic anion transport following portacaval shunt in patients with cirrhosis.
In patients with cirrhosis and bleeding esophageal varices, serum bilirubin level usually increases shortly after portasystemic anastomosis. The aim of the present study was to determine whether a change of the functional reserve capacity of the liver to store or excrete organic anions contributes to this post-shunt hyperbilirubinaemia. For this purpose, the relative hepatic storage capacity (S) and maximal biliary excretory rate (Tm) of bromsulphalein sodium (BSP) were estimated before and after elective portacaval shunts. Studies were performed in 13 cirrhotic patients who received less than 2 units of blood transfusion during the shunt procedure and none afterwards. S and Tm of BSP were determined preoperatively and 4 and 14 days after end-to-side portacaval shunt. Before shunt, S and Tm were significantly less in cirrhotic patients than in individuals with normal liver function. A further decrease of these values occurred 4 days after the shunt, suggesting that the deprivation of portal blood decreased the ability of liver to excrete organic anions. Two weeks postoperatively, S and Tm values were not different from the preoperative data demonstrating a recovery of organic anion transport capacity within a relatively short interval. The present data show that portacaval shunts temporarily reduce the organic anion excretory capacity of the cirrhotic liver. Therefore, large anion load, such as bilirubin derived from increased hemolysis, may temporarily saturate the excretory system, thereby inhibiting the elimination of other, potentially toxic, organic anions.
D000328:Adult; D000368:Aged; D001663:Bilirubin / Q000097:blood; D005260:Female; D006801:Humans; D008099:Liver / Q000378:metabolism*; D008103:Liver Cirrhosis / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011167:Portacaval Shunt, Surgical; D013448:Sulfobromophthalein
D013448:Sulfobromophthalein; D001663:Bilirubin