Circulating adrenomedullin is increased in relation with increased creatinine and atrial natriuretic peptide in liver-transplant recipients.
OBJECTIVE
Circulating adrenomedullin (ADM), a potent vasorelaxing and natriuretic peptide involved in cardiovascular homeostasis, is increased after cardiac and renal transplantation. ADM is also implicated in hemodynamic abnormalities during liver cirrhosis, but whether ADM is increased late after liver transplantation is unknown.


METHODS
A total of 18 subjects--10 liver-transplant patients (Ltx) and 8 healthy subjects--were enrolled in the study.


METHODS
After a 15-min rest period in supine position, heart rate and systemic blood pressure were determined in all subjects. Then, venous blood samples were obtained in order to simultaneously determine the cyclosporine through levels, the biological (cyclosporine, renal and hepatic functions) and hormonal (ADM and atrial natriuretic peptide (ANP)) characteristics of the Ltx.


RESULTS
ADM (27.2+/-4.1 vs. 53.8+/-6.9 pmol/l, P=0.02), and ANP (5.9+/-0.9 vs. 12.8+/-1.4 pmol/l, P=0.001) were significantly increased in late, stable Ltx (35.4+/-9.6 months after transplantation). Furthermore, increased ADM correlated positively with elevated creatinine (r=0.76, P=0.01) and ANP (r=0.64, P=0.04) after liver transplantation.


CONCLUSIONS
Liver-transplant patients exhibit a sustained increase in circulating ADM. Such an increase likely results from renal impairment associated with volume regulation abnormalities, suggesting a potential role for ADM in volume regulation after liver transplantation.
Geny
Bernard
B
Service de Physiologie Clinique et Equipe d'Accueil 3072, Institut de Physiologie, Faculté de Médecine, 67085 Strasbourg Cedex, France. Bernard.Geny@physio-ulp.u-strasbg.fr
Ellero
Bernard
B
Charloux
Anne
A
Brandenberger
Gabrielle
G
Doutreleau
Stéphane
S
Piquard
François
F
D053607:Adrenomedullin; D000328:Adult; D000704:Analysis of Variance; D009320:Atrial Natriuretic Factor / Q000097:blood*; D015992:Body Mass Index; D003401:Creatine / Q000097:blood*; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D008099:Liver / Q000378:metabolism; D008111:Liver Function Tests; D016031:Liver Transplantation; D008875:Middle Aged; D010455:Peptides / Q000097:blood*; D011184:Postoperative Period; D013997:Time Factors
D010455:Peptides; D053607:Adrenomedullin; D009320:Atrial Natriuretic Factor; D003401:Creatine