Transjugular intrahepatic portosystemic shunt-placement increases arginine/asymmetric dimethylarginine ratio in cirrhotic patients.
OBJECTIVE
To analyze the change of dimethylarginine plasma levels in cirrhotic patients receiving transjugular intrahepatic portosystemic shunt (TIPS).


METHODS
To determine arginine, asymmetric dimethylarginine (ADMA), symmetric dimethylarginine (SDMA), and nitric oxide (NO) plasma levels, blood samples were collected from the superior cava, hepatic, and portal vein just before, directly after, and 3 mo after TIPS-placement.


RESULTS
A significant increase in the arginine/ADMA ratio after TIPS placement was shown. Moreover, TIPS placement enhanced renal function and thereby decreased systemic SDMA levels. In patients with renal dysfunction before TIPS placement, both the arginine/ADMA ratio and creatinine clearance rate increased significantly, while this was not the case in patients with normal renal function before TIPS placement. Hepatic function did not change significantly after TIPS placement and no significant decline in ADMA plasma levels was measured.


CONCLUSIONS
The increase of the arginine/ADMA ratio after TIPS placement suggests an increase in intracellular NO bioavailability. In addition, this study suggests that TIPS placement does not alter dimethylarginine dimethylaminohydrolase (DDAH) activity and confirms the major role of the liver as an ADMA clearing organ.
Siroen
Michiel P C
MP
VU University Medical Center, Department of Surgery, PO Box 7057, Amsterdam 1007 MB, The Netherlands.
Wiest
Reiner
R
Richir
Milan C
MC
Teerlink
Tom
T
Rauwerda
Jan A
JA
Drescher
Friedrich T
FT
Zorger
Niels
N
van Leeuwen
Paul A M
PA
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001120:Arginine / Q000031:analogs & derivatives* / Q000097:blood*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006975:Hypertension, Portal / Q000503:physiopathology / Q000601:surgery; D008099:Liver / Q000378:metabolism / Q000601:surgery; D008103:Liver Cirrhosis / Q000097:blood* / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009569:Nitric Oxide / Q000097:blood; D019168:Portasystemic Shunt, Transjugular Intrahepatic
D009569:Nitric Oxide; C024917:symmetric dimethylarginine; C018524:N,N-dimethylarginine; D001120:Arginine