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

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. (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 remained 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 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 (115.3 +/- 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. (C) 2001 Lippincott Williams & Wilkins.