title: Hemodynamic and humoral changes after liver transplantation in patients with cirrhosis.
abstract: Splanchnic and systemic hemodynamics and plasma levels of aldosterone, glucagon and plasma renin were investigated in 12 patients with advanced cirrhosis before and 2 wk (14.6 +/- 2.8 days) and 2 mo (60.8 +/- 10.5 days) after orthotopic liver transplantation. Liver transplant was followed by significant (p < 0.01) changes in systemic hemodynamics at 2 wk, with a marked reduction in cardiac index (4.9 +/- 0.8 vs. 3.7 +/- 0.7 L/min.m2) and increases in mean arterial pressure (79 +/- 8 vs. 101 +/- 11 mm Hg) and peripheral vascular resistance (721 +/- 149 vs. 1,274 +/- 253 dyn.sec.cm-5). Two months after liver transplant, we saw further significant increases in peripheral vascular resistance (1,700 +/- 341 dyn.sec.cm-5; p < 0.05) without changes in cardiac index. Hepatic venous pressure gradient, very high before transplantation, was normal 2 wk after liver transplant (18.7 +/- 3.0 vs. 2.1 +/- 0.8 mm Hg; p < 0.01). Hepatic blood flow rose markedly from 1.03 +/- 0.46 to 2.25 +/- 0.79 L/min (p < 0.01) and was still elevated at 2 mo (1.84 +/- 0.74 L/min). Azygos blood flow had not changed after 2 wk with respect to pretransplant values (0.65 +/- 0.26 vs. 0.69 +/- 0.39 L/min) but had decreased significantly at 2 mo (0.39 +/- 0.16 L/min; p < 0.05). The elevated aldosterone, plasma renin and glucagon levels found in our cirrhotic patients before transplantation decreased to near-normal values 2 wk after the procedure. These results suggest that most of the hemodynamic and humoral abnormalities characteristic of advanced cirrhosis are reversed after liver transplant.(ABSTRACT TRUNCATED AT 250 WORDS)
authors.affiliation: Liver Unit, Hospital Clínic i Provincial, Barcelona, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Navasa
authors.forename: F
authors.initials: F
authors.lastname: Feu
authors.forename: J C
authors.initials: JC
authors.lastname: García-Pagán
authors.forename: W
authors.initials: W
authors.lastname: Jiménez
authors.forename: J
authors.initials: J
authors.lastname: Llach
authors.forename: A
authors.initials: A
authors.lastname: Rimola
authors.forename: J
authors.initials: J
authors.lastname: Bosch
authors.forename: J
authors.initials: J
authors.lastname: Rodés
mesh_terms: D006439:Hemodynamics; D006728:Hormones / Q000097:blood; D006801:Humans; D008103:Liver Cirrhosis / Q000097:blood / Q000503:physiopathology / Q000601:surgery*; D016031:Liver Transplantation; D008137:Longitudinal Studies; D011184:Postoperative Period; D011446:Prospective Studies; D013152:Splanchnic Circulation
chemical_list: D006728:Hormones