Transvascular Escape Rate of Albumin in Liver Cirrhosis, and its Possible Role in Formation of Ascites

Abstract

Transvascular escape rate of albumin (TER_a) was measured with ¹³¹I-RISA during hepatic vein catheterization in 10 males (age 46-67) with alcohol abuse and biopsy-verified liver cirrhosis. Portal hypertension (mean wedged hepatic vein pressure 26 ± 6.6 (S.D.) mm Hg), and low serum albumin concentration (mean 425 ± 90 (S.D.) μmol/l) were present. Diuretic treatment was given to 9 subjects. TER_a (mean 11.4 ± 3.1 (S.D.) per cent/hour) was substantially increased (P < 0.001) compared to normals (Parving & Gyntelberg, 1973). A positive correlation between the post-sinusoidal resistance and TER_a (r = 0.91, P <0.02) indicates an elevated splanchnic albumin escape rather than increased systemic transvascular escape. No significant correlation could be demonstrated between TER_a and wedged hepatic vein pressure. Negative correlation was demonstrated between TER, and the intravascular mass of albumin (r = −0.69, P <0.05). The total lymph flow, assuming steady state, was estimated as total albumin plasma clearance (plasma volume · TER_a), and was found to be high (mean 10.2 ± 2.9 (S.D.) 1/24 h). Subjects with tense ascites had a lower TER_a (P < 0.02) and total albumin plasma clearance than subjects without ascites. This may indicate that total lymph flow is smaller in patients with tense ascites, perhaps because of impeded lymphatic return.

Key-words:

• Albumin transport kinetics
• alcoholic cirrhosis
• ascites
• hepatic blood flow
• lymph flow
• portal hypertension
• transvascular escape rate of albumin