Nutrition and immunity after peritoneovenous drainage of intractable ascites in cirrhotic patients

Severe malnutrition and related impaired cell-mediated immunity are commonly found in cirrhotic patients with intractable ascites and may be responsible for the poor prognosis of these patients. The effects of LeVeen peritoneovenous shunting of ascites on protein reserves and cell-mediated immunity were studied in 31 cirrhotic patients with intractable ascites over a period of 1 year following operation. Arm-muscle circumference, serum albumin, and transferrin levels markedly increased and became close to the normal values. In the same period, delayed hypersensitivity improved. Although the lymphocyte count and the absolute T cell concentration in peripheral blood remained low after peritoneovenous shunting, the in vitro lymphoblastic transformation in response to phytohemagglutinin was augmented. An increased capacity to eat normal meals and the resumption of a good appetite due to the discontinuation of a salt-restricted diet seemed to be the most important factors in the dramatic improvement in the nutritional status of these patients. Restriction from heavy alcohol use may have also contributed, although the patients had already stopped drinking for several months before operation. Improvement in cell-mediated immunity might have been secondary to the increase in protein reserves.