title: Influence of endothelin-1 on hemodynamics during liver transplantation with and without temporary portocaval shunt: results of a clinical randomized study.
abstract: Aims of this study are to analyze the influence of endothelin-1 (ET-1) on hemodynamic evolution during liver transplantation (LT) and study the role of a temporary portacaval shunt in ET-1 synthesis. Forty LTs in patients with cirrhosis were studied. Two groups were analyzed: the first group had a temporary portacaval shunt during the anhepatic phase, and the second group did not. Portal and systemic ET-1 levels were measured at several times. At the end of the anhepatic phase, systemic (16.1 +/- 6.5 pg/mL) and portal (19.2 +/- 7 pg/mL) ET-1 levels increased, whereas they decreased after reperfusion (systemic, 11.8 +/- 7.1 pg/mL; portal, 13.2 +/- 6.8 pg/mL). Portal flow at the beginning of LT correlated with systemic ET-1 levels (R2 = 0.3; P =.004). A temporary portacaval shunt reduced portal pressure during the anhepatic phase, but did not modify ET-1 levels. Patients with reperfusion syndrome had greater systemic ET-1 levels in the anhepatic phase (19.1 +/- 6.9 v 15.1 +/- 6.1 pg/mL; P =.07). Although there is a relationship between ET-1 levels and portal flow and reperfusion syndrome, no clear clinical effect on hemodynamics could be shown. Creation of a portacaval shunt made no change in ET-1 levels.
authors.affiliation: Department of Surgery, Liver Transplant Unit, Ciudad Sanitaria Universitaria Bellvitge, University of Barcelona, Spain.
authors.forename: Laura
authors.initials: L
authors.lastname: Lladó
authors.forename: Emilio
authors.initials: E
authors.lastname: Ramos
authors.forename: Juan
authors.initials: J
authors.lastname: Figueras
authors.forename: Teresa
authors.initials: T
authors.lastname: Serrano
authors.forename: Jaume
authors.initials: J
authors.lastname: Torras
authors.forename: Antoni
authors.initials: A
authors.lastname: Rafecas
authors.forename: Joan
authors.initials: J
authors.lastname: Fabregat
authors.forename: Carmen
authors.initials: C
authors.lastname: Lama
authors.forename: Juli
authors.initials: J
authors.lastname: Busquets
authors.forename: Antonia
authors.initials: A
authors.lastname: Dalmau
authors.forename: Antonio
authors.initials: A
authors.lastname: Sabaté
authors.forename: Eduardo
authors.initials: E
authors.lastname: Jaurrieta
mesh_terms: D000328:Adult; D000368:Aged; D019332:Endothelin-1 / Q000502:physiology*; D005260:Female; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D007677:Kidney Function Tests; D008103:Liver Cirrhosis / Q000503:physiopathology* / Q000601:surgery*; D008111:Liver Function Tests; D016031:Liver Transplantation / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D011167:Portacaval Shunt, Surgical; D015427:Reperfusion Injury / Q000503:physiopathology
chemical_list: D019332:Endothelin-1