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

Abstract

Transvascular escape rate of albumin [TERa] was measured with iodine-labeled human serum albumin [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 (SD) mm Hg] and low serum albumin concentration [mean 425 .+-. 90 (SD) .mu.mol/l] were present. Diuretic treatment was given to 9 subjects. TERa [mean 11.4 .+-. 3.1% (SD)/h] was substantially increased (P < 0.001) compared to normals. A positive correlation between the post-sinusoidal resistance and TERa (r = 0.91, P < 0.02) indicated an elevated splanchnic albumin escape rather than increased systemic transvascular escape. Negative correlation was demonstrated between TERa and the intravascular mass of albumin (r = -0.69, P < 0.05). The total lymph flow was estimated as total albumin plasma clearance (plasma volume .cntdot. TERa), and was found high [mean 10.2 .+-. 2.9 (SD) l/24 h]. Subjects with tense ascites had a lower TERa (P < 0.02) and total albumin plasma clearance than subjects without ascites. Total lymph flow may be smaller in patients with tense ascites, perhaps from impeded lymphatic return.