Hypophosphatemia after hepatectomy or pancreatectomy: Role of the nicotinamide phosphoribosyltransferase Journal Article


Authors: Zheng, J.; Glezerman, I. G.; Sadot, E.; McNeil, A.; Zarama, C.; Gönen, M.; Creasy, J.; Pak, L. M.; Balachandran, V. P.; D'Angelica, M. I.; Allen, P. J.; DeMatteo, R. P.; Kingham, T. P.; Jarnagin, W. R.; Jaimes, E. A.
Article Title: Hypophosphatemia after hepatectomy or pancreatectomy: Role of the nicotinamide phosphoribosyltransferase
Abstract: Background: Postoperative hypophosphatemia is common and is associated with a lower risk of liver failure after hepatectomy, but higher morbidity after pancreatectomy. Whether different physiologic mechanisms underlie the hypophosphatemia associated with these very different clinical outcomes is unclear. This study aims to evaluate the underlying mechanism in postoperative hypophosphatemia. Study Design: We prospectively enrolled 120 patients who underwent major hepatectomy (n = 30), minor hepatectomy (n = 30), pancreatectomy (n = 30), and laparotomy without resection (control group, n = 30). Preoperative and postoperative serum and urinary phosphorus, calcium, and creatinine, as well as phosphaturic factors, including serum nicotinamide phosphoribosyltransferase (NAMPT), fibroblast growth factor-23, and parathyroid hormone were measured. In addition, we evaluated urinary levels of nicotinamide catabolites, N-methyl-2-pyridone-5-carboxamide and N-methyl-4-pyridone-3-carboxamide. Results: We found that significant hypophosphatemia occurred from postoperative day (POD) 1 to POD 2 in all 4 groups and was preceded by hyperphosphaturia from preoperative day to POD 1. Phosphate level alterations were associated with a significant increase in NAMPT levels from preoperative day to POD 2 in all 3 resected groups, but not in the control group. The fibroblast growth factor-23 levels were significantly decreased postoperatively in all 4 groups, and parathyroid hormone levels did not change in any of the 4 groups. Urine levels of N-methyl-2-pyridone-5-carboxamide and N-methyl-4-pyridone-3-carboxamide decreased significantly in all 4 groups postoperatively. Conclusions: This study demonstrates that the mechanism of hypophosphatemia is the same for both liver and pancreas resections. Postoperative hypophosphatemia is associated with increased NAMPT. The mechanism that upregulates NAMPT and its role on disparate clinical outcomes in postoperative patients warrant additional investigation. © 2017 American College of Surgeons
Keywords: adult; aged; aged, 80 and over; middle aged; case control study; case-control studies; hypophosphatemia; prospective study; prospective studies; metabolism; postoperative complications; cytokine; cytokines; pancreatectomy; liver resection; hepatectomy; adverse effects; nicotinamide phosphoribosyltransferase; very elderly; humans; human; male; female; nicotinamide phosphoribosyltransferase, human
Journal Title: Journal of the American College of Surgeons
Volume: 225
Issue: 4
ISSN: 1072-7515
Publisher: Elsevier Science, Inc.  
Date Published: 2017-10-01
Start Page: 488
End Page: 497.e2
Language: English
DOI: 10.1016/j.jamcollsurg.2017.06.012
PUBMED: 28690207
PROVIDER: scopus
PMCID: PMC5614834
DOI/URL:
Notes: Article -- Export Date: 1 May 2018 -- Source: Scopus
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MSK Authors
  1. Ronald P Dematteo
    588 Dematteo
  2. Mithat Gonen
    687 Gonen
  3. Peter Allen
    427 Allen
  4. William R Jarnagin
    569 Jarnagin
  5. T Peter Kingham
    281 Kingham
  6. Eran Sadot
    35 Sadot
  7. Edgar Alberto Jaimes
    23 Jaimes
  8. Linda Ma
    16 Ma
  9. Jian Ying Zheng
    13 Zheng
  10. John Creasy
    9 Creasy
  11. Anjuli J. McNeil
    1 McNeil