DISTRIBUTION OF BODY-WATER IN PATIENTS WITH CIRRHOSIS - THE EFFECT OFLIVER-TRANSPLANTATION

We compared total body water and intracellular-extracellular distribut ion of body water between male patients with mild liver disease withou t ascites (n = 9), male patients with severe liver disease and gross a scites (n = 6) and a group of age-, sex-, height- and weight- matched controls (n = 6). In addition, we documented the effects of liver tran splantation on intracellular, extracellular and total body water in 12 patients (6 men and 6 women) by means of deuterium oxide dilution and whole-body potassium counting. We saw no significant difference in to tal body water between the healthy controls, patients without ascites and patients with ascites (46.5 +/- 9.2 kg, 45.4 +/- 6.6 kg and 50.4 /- 5.1 kg, respectively), although, as expected, extracellular water w as increased in patients with ascites compared with healthy controls a nd cirrhotic patients without ascites (36.9 +/- 6.5 kg vs. 25.4 +/- 4. 4 kg, p = 0.005; and 36.9 +/- 6.5 kg vs. 27.0 +/- 5.3 kg, p = 0.002, r espectively). We found no difference between nonascitic patients and h ealthy controls (25.4 +/- 4.4 kg vs. 27.0 +/- 5.3 kg). However, intrac ellular water was significantly reduced in patients with severe liver disease compared with that in controls (13.6 +/- 3.3 kg vs. 21.5 +/- 4 .2 kg, p = 0.005) or patients without ascites (13.6 +/- 3.3 kg vs. 18. 3 +/- 2.9 kg, p = 0.01). The reduction of intracellular water appears to be due to loss of body cell mass. The mean body weight of the group of patients who were studied before and 3 mo after liver transplantat ion did not change (69.0 +/- 10.2 kg vs. 69.0 +/- 11.1 kg), but we not ed significant decreases in mean total body water and mean extracellul ar water (43.5 +/- 9.0 kg vs. 40.5 +/- 7.6 kg, p = 0.02; and 27.8 +/- 5.6 kg vs. 24.5 +/- 4.8 kg, p = 0.02, respectively). This loss of wate r appeared to be compensated for by increases in body fat rather than body cell mass; the 3-mo posttransplant total body potassium value was not significantly different from the pretransplant value (98.1 +/- 28 .5 gm vs. 99.9 +/- 19.0 gm). This study confirmed that abnormalities i n water compartments occur in decompensated cirrhosis. However, in con trast to a previous report, we saw no significant increase in extracel lular water in patients without obvious fluid retention. Furthermore, changes in water compartments occur soon after liver transplantation ( loss of total body water and extracellular water), despite body weight maintenance. The constance of body weight in the early stages after l iver transplantation is predominantly due to an increase in body fat s tores rather than to an increase in body cell mass.