Partial Splenic Embolization Reverses Insulin Resistance in Patients with Liver Cirrhosis

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Background It is well known that patients with liver cirrhosis often develop insulin resistance and diabetes mellitus. Recently, we encountered a liver cirrhosis patient in whom partial splenic embolization (PSE) improved insulin sensitivity. Therefore, we conducted further investigation about PSE and insulin resistance. Methods Thirty-seven consecutive patients with liver cirrhosis underwent PSE. Hemodynamic changes, blood counts, and homeostasis model assessment of insulin resistance (HOMA-IR) were assessed before and 2 weeks after PSE. Results PSE resulted in decreased splenic venous flow and increased intestinal venous flow to the liver. Platelet counts before and after PSE were 7.7±0.5×104 /μL, 15.0±1.4×104 /μL, respectively (p<0.01). HOMA-IR before and after PSE were 6.5±2.1, 3.3±0.6, respectively (p<0.05). HCV core antigen before and after PSE were 6,340±1,296 fmol/L, 4,112±873 fmol/L, respectively (p<0.05). Conclusion PSE significantly reverses insulin resistance in patients with liver cirrhosis. The increase in intestinal venous flow to the liver and reduced HCV viral load were thought to be mechanisms of improvement in insulin sensitivity after PSE.