The effect of liver transplantation on circulating levels of estradiol andprogesterone in male patients: Parallelism with hepatopulmonary syndrome and systemic hyperdynamic circulation improvement

The correction of hepatopulmonary syndrome (HPS) after liver transplantatio n (LT) remains controversial. The aims of our study were to: 1)analyze whet her LT reverses HPS; 2) note any relationship between HPS and the systemic hemodynamic disturbance; and 3) note changes in circulating sex hormones an d the possible association with pulmonary and systemic hemodynamic changes. Systemic hemodynamic parameters, cardiac output and systemic vascular resi stance (SVR), sex hormones, and intrapulmonary vasodilatation assessed by c ontrast transesophageal echocardiography, and gas exchange abnormalities we re investigated in 19 patients with advanced cirrhosis prior to and 6 month s (176.8 +/- 30 days) after LT. LT was followed by a marked reduction in ca rdiac output (6.6 +/-1.7 vs 3.5 +/-0.5 l/min; p<0.001) and SVR (1039<plus/m inus>460 vs 1978 +/- 294 dyn.sec.cm(-5); p<0.005). Before LT, circulating e stradiol and progesterone levels were invariably elevated (66<plus/minus>22 pg/ml and 1.8 +/-1.1 ng/ml, respectively, normal values <31 pg/ml and 0.35 ng/ml, respectively), and dropped after LT (28<plus/minus>12 pg/ml p<0.001 and 0.38<plus/minus>0.2 ng/ml; p<0.001, respectively). Seventeen of 19 pat ients had intrapulmonary vasodilatation and increased alveolar-arterial oxy gen difference, thereby fulfilling diagnostic criteria for HPS. Patients wi th HPS presented higher cardiac output (p<0.05), lower SVR (p<0.01), and hi gher progesterone and estradiol levels than patients without HPS (p<0.05). LT produced normalization of intrapulmonary vasodilatation in all patients. LT normalized hyperdynamic circulation and is a useful therapeutic option in patients with HPS. Normalization of sex hormone levels after LT suggests that they could play a pathogenic role in the development of HPS, (J. Endo crinol. Invest. 24: 503-509, 2001) (C) 2001, Editrice Kurtis.