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

Objectives To study candidates for liver transplant before and 6 weeks afte r transplant, and to elucidate the role of endothelial dysfunction and plas ma endothelin concentrations in the development of hypertension. Design Prospective follow-up 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 (115.3 +/- 2.6 pg/ml) compared with controls (5.6 +/- 0.4 pg/ml; P < 0.001) and r emained unchanged 6 weeks after liver transplantation (14.1 +/- 3.7 pg/ml). 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 o f comparable age and sex. Methods We performed office blood pressure readings and 24 h ambulatory blo od pressure monitoring (ABPM), measurements of endothelial-dependent vasodi latation using high-resolution ultrasound in the brachial artery at rest an d 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 significant ly 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 11 8.7 +/- 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 < 0.0 5). 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 (115.3 +/- 2.6 pg/ml) compared with c ontrols (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 circad ian blood pressure variability in liver graft recipients 6 weeks after tran splant and no change in endothelial function and plasma endothelin concentr ations. Therefore, the blood pressure increase documented in our study cann ot be explained by endothelial dysfunction. Twenty-four hour ABPM should be performed routinely in patients who have undergone liver transplant. (C) 2 001 Lippincott Williams & Wilkins.