Spontaneous baroreflex cardiac sensitivity in end-stage liver disease: effect of liver transplantation.
OBJECTIVE
End-stage liver disease is associated with an imbalance in the autonomic nervous system. The purpose of this study was to estimate the effect of liver transplantation on this imbalance.


METHODS
The study involved 10 patients undergoing liver transplantation and 9 patients without liver impairment undergoing liver surgery. The spontaneous baroreflex sensitivity was measured before and 1 month after surgery for the liver surgery group; before and 1, 3, 6, 12 and 18 months after orthotopic liver transplantation.


RESULTS
The spontaneous baroreflex slope of patients with end-stage liver disease was decreased before liver transplantation compared to the liver surgery group (3.9 +/- 2.5 ms mmHg(-1) vs. 9.9 +/- 5.0 ms mmHg(-1), P = 0.002). The mean slope was significantly increased at 12 and 18 months compared to the pre-transplantation value (3.9 +/- 2.5 ms mmHg(-1) vs. 8.1 +/- 6.6 ms mmHg(-1) and 7.4 +/- 4.8 ms mmHg(-1), respectively; P = 0.042). Nevertheless, further analysis of individual data showed that only four patients exhibited a marked increase in their baroreflex slope 12 months after the liver transplantation whereas it remained decreased in the six others.


CONCLUSIONS
These results confirm that the baroreflex sensitivity is depressed in end-stage liver disease in line with an autonomic nervous system imbalance. The liver transplantation reverses this disturbance only in some patients.
Lhuillier
F
F
Department of Anaesthesia and Intensive Care, Hôpital de la Croix-Rousse, Lyon, France.
Dalmas
E D
ED
Gratadour
P M
PM
Cividjian
A A
AA
Boillot
O C
OC
Quintin
L
L
Viale
J P
JP
D000704:Analysis of Variance; D001342:Autonomic Nervous System Diseases / Q000503:physiopathology*; D017704:Baroreflex / Q000502:physiology; D005260:Female; D005500:Follow-Up Studies; D006321:Heart / Q000294:innervation* / Q000503:physiopathology; D006801:Humans; D008099:Liver / Q000601:surgery; D008107:Liver Diseases / Q000503:physiopathology / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D013997:Time Factors; D016896:Treatment Outcome