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

We compared total body water and intracellular-extracellular distribution of body water between male patients with mild liver disease without ascites (n = 9), male patients with severe liver disease and gross ascites (n = 6) and a group of age-, sex-, height- and weight- matched controls (n = 6). In addition, we documented the effects of liver transplantation 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 total 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 was increased in patients with ascites compared with healthy controls and 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, respectively). We found no difference between nonascitic patients and healthy controls (25.4 +/- 4.4 kg vs. 27.0 +/- 5.3 kg). However, intracellular 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 transplantation did not change (69.0 +/- 10.2 kg vs. 69.0 +/- 11.1 kg), but we noted significant decreases in mean total body water and mean extracellular 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 water 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 in water compartments occur in decompensated cirrhosis. However, in contrast to a previous report, we saw no significant increase in extracellular 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 liver transplantation is predominantly due to an increase in body fat stores rather than to an increase in body cell mass.