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Effect of branched-chain amino acid supplementation on functional liver regeneration in patients undergoing portal vein embolization and sequential hepatectomy: a randomized controlled trial

  • Original Article—Liver, Pancreas, and Biliary Tract
  • Published:
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Abstract

Background

Portal vein embolization (PVE) can decrease the resection ratio for major hepatectomy. 99mTc-galactosyl human serum albumin (GSA) scintigraphy is useful for evaluating quantitative functional liver volume. Branched chain amino acids (BCAAs) modulate liver function and regeneration. We analyzed the effects of BCAAs, in terms of liver function and regeneration after PVE, in combination with major hepatectomy.

Methods

This randomized controlled trial was conducted for patients receiving PVE through to complete hepatectomy from September, 2011 to June, 2013. BCAA granules were added two times a day to a conventional diet in the BCAA administration group (BCAA group). The primary end point was functional liver regeneration of the future remnant liver after PVE followed by hepatic resection. Functional liver regeneration was assessed by the liver uptake value obtained from 99mTc-GSA scintigraphy single-photon-emission computed tomography/computed tomography fusion images. The secondary end points were volumetric liver regeneration and changes in liver function and laboratory data.

Results

A BCAA group (n = 13) and a non-BCAA group (control group; n = 15) were included. The primary end point was partially met: the liver uptake value significantly increased in the BCAA group compared with the control group 6 months after hepatic resection (266.7 % vs 77.6 %, P = 0.04) and marginally increased after PVE (43.8 % vs 17.4 %, P = 0.079). Following PVE, the increment of the uptake ratio of the liver to the liver plus heart at 15 min was significantly less in the BCAA group than in the control group (0.0 and 0.01, P = 0.023).

Conclusions

BCAA supplementation improved functional liver regeneration and function in patients undergoing PVE followed by major hepatic resection.

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Abbreviations

BCAA:

Branched-chain amino acid

BTR:

Branched-chain amino acid and tyrosine ratio

CT:

Computed tomography

ICGR15:

Indocyanine green retention rate at 15 min

LHL15:

Uptake ratio of the liver to the liver plus heart at 15 min

LUV:

Liver uptake value

PVE:

Portal vein embolization

SPECT:

Single-photon-emission computed tomography

99mTc-GSA:

Technetium-99m galactosyl human serum albumin

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Acknowledgments

We are sincerely grateful to the participating patients and their families. We are indebted to the physicians and all co-medical staff, especially Megumi Yoshida for her excellent collection and management of data, and secretarial assistance.

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, 1-1-1 Honjo, chuo-Ku, Kumamoto, 860-8556, Japan

    Toru Beppu, Hidetoshi Nitta, Hiromitsu Hayashi, Katsunori Imai, Hirohisa Okabe, Shigeki Nakagawa, Daisuke Hashimoto, Akira Chikamoto, Takatoshi Ishiko & Hideo Baba

  2. Department of Multidisciplinary Treatment for Gastroenterological Cancer, Kumamoto University Hospital, Kumamoto, 860-8556, Japan

    Toru Beppu

  3. Department of Diagnostic Radiology, Graduate School of Life Sciences, Kumamoto University, 1-1-1 Honjo, chuo-Ku, Kumamoto, 860-8556, Japan

    Morikatsu Yoshida & Yasuyuki Yamashita

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  1. Toru Beppu
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  2. Hidetoshi Nitta
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Correspondence to Hideo Baba.

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Beppu, T., Nitta, H., Hayashi, H. et al. Effect of branched-chain amino acid supplementation on functional liver regeneration in patients undergoing portal vein embolization and sequential hepatectomy: a randomized controlled trial. J Gastroenterol 50, 1197–1205 (2015). https://doi.org/10.1007/s00535-015-1067-y

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  • DOI: https://doi.org/10.1007/s00535-015-1067-y

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