Influence of endothelin-1 on hemodynamics during liver transplantation with and without temporary portocaval shunt: results of a clinical randomized study.
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.
Lladó
Laura
L
Department of Surgery, Liver Transplant Unit, Ciudad Sanitaria Universitaria Bellvitge, University of Barcelona, Spain.
Ramos
Emilio
E
Figueras
Juan
J
Serrano
Teresa
T
Torras
Jaume
J
Rafecas
Antoni
A
Fabregat
Joan
J
Lama
Carmen
C
Busquets
Juli
J
Dalmau
Antonia
A
Sabaté
Antonio
A
Jaurrieta
Eduardo
E
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
D019332:Endothelin-1