Physiological and clinical implications of proANP(1-98) circulating levelsin the perioperative phase of liver transplantation

Background: ProANP(1-126), the prohormone synthesized and secreted by atria l myocites, generates an ANP peptide family, the main forms of which are pr oANP(1-30), proANP(31-67), proANP(1-98) and proANP(99-126). These molecular circulating forms are involved in hemodynamic and electrolyte homeostasis. In cirrhotic patients, volume homeostasis is almost impaired due to abnorm al sodium retention, which results in ascites formation and hemodynamic cha nces, including high cardiac output and low systemic vascular resistance. D uring liver transplantation, in the anhepatic phase, hemodynamic instabilit y may occur because of decreased venous return due to surgical manipulation of inferior vena cava, considerable blood loss or cross-clamping. Moreover , marked hemodynamic instability is often observed at the reperfusion of th e graft. Aims: The aims of present study are to investigate the changes of ANP during the perioperative phases of Orthotopic Liver Transplantation (OL Tx) in end-stage cirrhotic patients. Patients and methods: From July to Sep tember 1999, 11 cirrhotic patients undergoing to OLTx were included in the study: seven males and four females (average age 46 +/- 10.4 years) affecte d by post-alcoholic cirrhosis [Hypertension 15 (1990) 9], post-hepatitis ci rrhosis [D.G. Gardner, M.C. Lapointe, B. Kovacic-Milivojevic, C.F. Deschepp er, Molecular analisys and regulation of the atrial natriuretic factor g-en e, in: A.D. Struphers (Ed.), Frontiers in Farmacology and Therapeutics: Atr ial Natriuretic Factor, Blackwell, Oxford, England, 1991, pp. 1-22], Wilson disease [Life Sci. 28 (1981) 89], and policistic disease [Life Sci. 28 (19 81) 89], autoimmune cirrhosis [Life Sci. 28 (1981) 89]. In each patient, a hemodynamic assessment was achieved using a Swan-Ganz catheter. Pediferical venous samples were performed during and immediately after OLTx for the de termination of ANP(1-98) and other biohumoral parameters. Results: [GRAPHICS] Mean ANTK(1-98) (pmol/ml mean +/- SD) basal levels resulted higher than tha t recorded in the group of healthy subjects. A significant correlation betw een 24-h post-reperfusion ANP and intra-operative RBC and RIS requirement w as found ( p < 0.05) The basal values resulted significantly higher than th at observed at phase II<degrees> (p<0.04) and lower than that at phase VI<d egrees> (p < 0.05); the anesthectic induction values were significantly low er than that observed at phase VI<degrees> (p<0.03). Conclusions: ANP(1-98) values may represent a useful marker of hemodynamic derangements during an d after OLTx. Further clinical correlations will need a larger patient basi s. (C) 2001 Elsevier Science B.V. All rights reserved.