Blood pressure, endothelial function and circulating endothelin concentrations in liver transplant recipients.
OBJECTIVE
To study candidates for liver transplant before and 6 weeks after transplant, and to elucidate the role of endothelial dysfunction and plasma endothelin concentrations in the development of hypertension. DESIGN PROSPECTIVE: follow-up study.


METHODS
Institutional, outpatient.


METHODS
and controls Fifteen patients (11 men, four women, mean age 46.7+/-13.2 years) with end-stage liver disease (ESLD) and healthy volunteers of comparable age and sex.


METHODS
We performed office blood pressure readings and 24 h ambulatory blood pressure monitoring (ABPM), measurements of endothelial-dependent vasodilatation using high-resolution ultrasound in the brachial artery at rest and during reactive hyperemia, and plasma endothelin-1 assays 3 months before and 6 weeks after the transplant.


RESULTS
Office systolic and diastolic blood pressures increased significantly 6 weeks after liver transplantation (from 116.6+/-14.1 to 139.9+/-19.5 mmHg and from 68.6+/-9.5 to 84.1+/-9.8 mmHg, respectively; both P < 0.001). Hypertension based on office blood pressure readings increased from 6.7 to 40% (P < 0.05). Mean 24 h systolic blood pressure increased from 118.7+/-10.3 to 140.0+/-19.0 mmHg (P < 0.001), mean 24 h diastolic blood pressure increased from 86.0+/-7.7 to 104.8+/-13.9 mmHg (P < 0.001) and heart rate increased from 74.8+/-10.2 to 80.2+/-8.2 beats/min (P < 0.05). Brachial artery flow-mediated dilatation did not change throughout the study (before transplant: 4.2+/-4.0%; after transplant: 6.3+/-5.4%; NS) and did not differ from that in controls (5.2+/-3.8%). Plasma endothelin-1 was increased in patients with ESLD (15.3+/-2.6 pg/ml) compared with controls (5.6+/-0.4 pg/ ml; P < 0.001) and remained unchanged 6 weeks after liver transplantation (14.1+/-3.7 pg/ml).


CONCLUSIONS
Our results show increased blood pressure with suppressed circadian blood pressure variability in liver graft recipients 6 weeks after transplant and no change in endothelial function and plasma endothelin concentrations. Therefore, the blood pressure increase documented in our study cannot be explained by endothelial dysfunction. Twenty-four hour ABPM should be performed routinely in patients who have undergone liver transplant.
Cífková
R
R
Department of Preventive Cardiology, Charles University Medical School I, Prague, Czech Republic. recf@medicon.cz
Pit'ha
J
J
Trunecka
P
P
Lánská
V
V
Jindra
A
A
Plásková
M
M
Peterková
L
L
Hrncárková
H
H
Horký
K
K
D000328:Adult; D001794:Blood Pressure; D001795:Blood Pressure Determination / Q000379:methods; D018660:Blood Pressure Monitoring, Ambulatory; D001916:Brachial Artery / Q000503:physiopathology; D019332:Endothelin-1 / Q000097:blood*; D004730:Endothelium, Vascular / Q000503:physiopathology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D017093:Liver Failure / Q000503:physiopathology* / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D009819:Office Visits; D009994:Osmolar Concentration; D011184:Postoperative Period; D011446:Prospective Studies; D012016:Reference Values; D014664:Vasodilation / Q000502:physiology
D019332:Endothelin-1