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Blood pressure, endothelial function and circulating endothelin concentrations in liver transplant recipients

Cífková, Renataa; Pit'ha, Jana; Trunecuka, Pavelb; Lánská, Vera; Jindra, Antonínd; Plásuková, Markétaa; Peterková, Ludmilaa; Hrncuárková, Halimab; Horký, Kareld

Original papers: Endothelium

Objectives: 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.

Setting: Institutional, outpatient.

Patients 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).

Conclusion: 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.

Departments of aPreventive Cardiology, bHepatogastroenterology and cStatistics, Institute for Clinical and Experimental Medicine, and dDepartment of Medicine II, Charles University Medical School I, Prague, Czech Republic.

Received 28 August 2000

Revised 8 March 2001

Accepted 9 March 2001

Sponsorship: This work was supported by grants NA/4942-3, NA/5615-3, and NA/5301-3 awarded by the Internal Grant Agency, Ministry of Health, Czech Republic.

Correspondence and requests for reprints to Dr Renata Cífková, Department of Preventive Cardiology, Institute for Clinical and Experimental Medicine, Vídenuská 1958/9, 140 21 Prague 4, Czech Republic. Tel: +420 2 617 11 399; fax: +420 2 617 10 666; e-mail:

© 2001 Lippincott Williams & Wilkins, Inc.