title: A Randomized Clinical Trial of Preoperative Administration of Branched-Chain Amino Acids to Prevent Postoperative Ascites in Patients with Liver Resection for Hepatocellular Carcinoma.
abstract: Massive postoperative ascites remains a major threat that can lead to liver failure and other fatal complications, especially in patients with poor liver function. Branched-chain amino acid (BCAA) administration increases biosynthesis and secretion of albumin by hepatocytes and increases oncotic pressure by elevating blood albumin concentration, thereby decreasing peripheral edema, ascites, and pleural effusion.
  
  
  
  We randomly allocated consecutive patients undergoing major liver resection for hepatocellular carcinoma to either a group where oral BCAA administration was initiated 3 weeks before liver resection, or a non-BCAA group. The primary study endpoint was development of postoperative ascites.
  
  
  
  Overall, 39 patients were allocated to the BCAA group, while 38 were assigned to the non-BCAA group. No significant difference in the rate of refractory ascites, considered alone, was evident between the BCAA (5.1 %) and non-BCAA groups (13.2 %; p = 0.263). However, the occurrence of refractory ascites and/or pleural effusion was significantly less frequent in the BCAA group (5.1 %) than in the non-BCAA group (21.1 %; p = 0.047). Furthermore, the postoperative serum concentration of reduced-state albumin was greater immediately after liver resection in the BCAA group than in the non-BCAA group.
  
  
  
  Preoperative administration of BCAA did not significantly improve prevention of refractory ascites, but significant effectiveness in preventing ascites, pleural effusion, or both, as well as improving metabolism of albumin, was demonstrated [University Hospital Medical Information Network (UMIN) reference number 000004244].
authors.affiliation: Department of Surgery, Teikyo University Chiba Medical Center, Chiba, Japan.
authors.forename: Yutaro
authors.initials: Y
authors.lastname: Kikuchi
authors.affiliation: Department of Surgery, Teikyo University Chiba Medical Center, Chiba, Japan.
authors.forename: Yukihiko
authors.initials: Y
authors.lastname: Hiroshima
authors.affiliation: Department of Surgery, Teikyo University Chiba Medical Center, Chiba, Japan.
authors.forename: Kenichi
authors.initials: K
authors.lastname: Matsuo
authors.affiliation: Department of Surgery, Teikyo University Chiba Medical Center, Chiba, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Kawaguchi
authors.affiliation: Department of Surgery, Teikyo University Chiba Medical Center, Chiba, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Murakami
authors.affiliation: Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Yabushita
authors.affiliation: Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan.
authors.forename: Itaru
authors.initials: I
authors.lastname: Endo
authors.affiliation: Department of Biostatistics and Epidemiology, Yokohama City University Graduate School of Medicine, Yokohama, Japan.
authors.forename: Masataka
authors.initials: M
authors.lastname: Taguri
authors.affiliation: Department of Surgery, Teikyo University Chiba Medical Center, Chiba, Japan.
authors.forename: Keiji
authors.initials: K
authors.lastname: Koda
authors.affiliation: Department of Surgery, Teikyo University Chiba Medical Center, Chiba, Japan. u17-92ts@med.teikyo-u.ac.jp.|Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan. u17-92ts@med.teikyo-u.ac.jp.
authors.forename: Kuniya
authors.initials: K
authors.lastname: Tanaka
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000597:Amino Acids, Branched-Chain / Q000627:therapeutic use*; D001201:Ascites / Q000209:etiology / Q000517:prevention & control*; D006528:Carcinoma, Hepatocellular / Q000601:surgery*; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects; D006801:Humans; D008113:Liver Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010996:Pleural Effusion / Q000209:etiology / Q000517:prevention & control; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control*; D011300:Preoperative Care; D012709:Serum Albumin / Q000187:drug effects / Q000378:metabolism
chemical_list: D000597:Amino Acids, Branched-Chain; D012709:Serum Albumin