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. 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.

The role of ERCP in management of biliary complications after liver transplantation.

Biliary complications remain to pose a serious problem in patients after liver transplantation. In the past, they occurred in as many as 50% of patients, and were associated with a height mortality. This has changed and at present the incidence of this complications is lower. The authors present their own series and discuss the role of ERCP in the management of complications.

[Evaluation of kidney function in patients before and after orthotopic liver transplantation]. / Hodnocení funkce ledvin u pacientu pred a po ortotopické transplantaci jater.

Subjects before and after orthotopic transplantation of the liver develop frequently renal disorders. Evaluation of the renal function based on the serum creatinine concentration or its clearance is difficult in these cases because the concurrent hyperbilirubinaemia usually interferes with the method used for creatinine assessment (based on Jaffé's positive chromogen) and gives incorrect lower values. In the submitted work the authors investigated the development of the serum creatinine concentration and serum bilirubin concentration in 50 subjects before and one year after transplantation of the liver. The findings suggest that although under conditions of hyperbilirubinaemia creatinine cannot be evaluated by the usual methods, it is possible to obtain clinically useful information by investigating the trend of the relationship of creatinine and bilirubin. A decline of bilirubin is associated with a rise of creatinine which need not imply a decline of renal function, as long as creatinine does not exceed the upper range of normal values. Conversely the rise of bilirubin associated with a drop of creatinine need not imply improved renal function. In the investigated group one year after transplantation of the liver an impaired renal function (creatinine > 105 mumol/l) at a normal bilirubin level (< 21 mumol/l) in 17 (49%) subjects was found. In 7 (64%) subjects with hyperbilirubinaemia the creatinine value was within a normal range--this finding however does not rule out reduced renal function. Evaluation of renal function with concurrent hyperbilirubinaemia calls for more accurate methods. With regard to the mentioned findings however investigation of the trend creatinine/bilirubin makes it possible to evaluate the dynamics of changes of renal function.

Liver transplantation in Eastern Europe.

The aim of this report is to evaluate the development of liver transplantation in eastern Europe until mid-1998. Representatives of gastroenterological and hepatological societies of the respective countries answered a questionnaire about the most descriptive items of the issue of liver transplantation. The Baltic countries, together with 6 southern Balkan countries, Moldovia, and Belarus, have not developed a program of liver transplantation. In Ukraine, 7 transplantations were performed, with 3 early deaths. In Russia, 31 liver transplantations were performed, with 8 of the last 12 patients surviving short term. In Slovenia, 1 of 2 patients, and in Yugoslavia, 8 of 9 patients survived. In Croatia and Slovakia, 2 patients each died immediately after surgery. The number of liver transplantations is increasing in both Hungary and Poland. In Hungary, 63 transplantations were performed, with a 1-year survival rate reaching 85%; in Poland, 55 adults and 29 children underwent transplantation, with an actuarial 1-year survival rate of 70%. In former East Germany, 4 centers developed their programs since 1992. A total of 196 transplantations were performed, with 1-year survival rates varying from 80% to 89%. The total spectrum of indications for transplantation was standard, with a greater proportion of hepatocellular cancer compared with Eurotransplant statistics. In the Czech Republic, the first liver transplantation was performed in 1983, but it was not until 1994 that the number of procedures increased steeply. Until mid-1998, a total of 182 transplantations were performed. At the Prague Institute for Clinical and Experimental Medicine, we performed 94 transplantations, with a 1-year patient survival rate of 90.6%. There has been rapid development over the last 3 years in the 3 countries of Central Europe. The progress is influenced by the sweeping political and economic changes.

[Gynecologic operations in patients after kidney and liver transplantation--case report]. / Gynekologické operace u pacientek po transplantaci ledviny a jater--kazuistiky.

OBJECTIVE: To give an overview of the complications associated with the post-transplantation period which thus presents an increased risk for subsequent gynecological surgery and also for the postoperative period. To determine the criteria and conditions under which these operations may be performed with relative safety. TYPE OF STUDY: Case report. SUBJECT OF STUDY: Described surgical treatment of gynecological diseases in three patients after liver and kidney transplantation. CONCLUSION: A summary of the principles/basics of patient care after surgery for gynecological indications with a prior organ transplant in ther patient's history. These patients should undergo surgery in hospitals with a high quality of professional care as well as high quality equipment and cooperation among the specialists from the various medical fields involved.

T1 and T2 alterations in the brains of patients with hepatic cirrhosis.

PURPOSE: To determine whether previously reported T1-weighted MR hyperintensities in the brains of patients with hepatic cirrhosis are accompanied by changes in T2. METHODS: We measured T1 and T2 in the brains of 10 patients with chronic liver disease and 7 age-matched healthy volunteers, using classic spin-echo sequences with multiple saturation recovery times and multiple echoes. RESULTS: Both T1 and T2 were shortened in the basal ganglia, cortex, and white matter of the patients, with the greatest shortening in the globus pallidus, where 1/T1 was increased by 0.76 s-1 or 74% and 1/T2 by 1.45 s-1 or 11%. CONCLUSIONS: The T1 changes were accompanied by T2 changes of greater magnitude that were not as visible because T2 is normally much shorter than T1, especially in the globus pallidus.