Hemodynamic response to propranolol in patients with recurrent hepatitis C virus–related cirrhosis after liver transplantation: A case-control study

Authors

  • Filippo Schepis,

    1. Hepatic Hemodynamic Laboratory and Liver Transplantation Section, Barcelona, Spain
    2. Network Center for Biomedical Research in Hepatic and Digestive Diseases (CIBERehd), Barcelona, Spain
    3. Gastroenterology Unit, University Hospital of Modena, University of Modena and Reggio Emilia, Modena, Italy
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    • These authors contributed equally to this work.

  • Ranka Vukotic,

    1. Hepatic Hemodynamic Laboratory and Liver Transplantation Section, Barcelona, Spain
    2. Network Center for Biomedical Research in Hepatic and Digestive Diseases (CIBERehd), Barcelona, Spain
    3. Gastroenterology Unit, University Hospital of Modena, University of Modena and Reggio Emilia, Modena, Italy
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    • These authors contributed equally to this work.

  • Annalisa Berzigotti,

    1. Hepatic Hemodynamic Laboratory and Liver Transplantation Section, Barcelona, Spain
    2. Network Center for Biomedical Research in Hepatic and Digestive Diseases (CIBERehd), Barcelona, Spain
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  • José A. Carrión,

    1. Hepatic Hemodynamic Laboratory and Liver Transplantation Section, Barcelona, Spain
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  • Xavier Forns,

    1. Hepatic Hemodynamic Laboratory and Liver Transplantation Section, Barcelona, Spain
    2. Network Center for Biomedical Research in Hepatic and Digestive Diseases (CIBERehd), Barcelona, Spain
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  • Juan G. Abraldes,

    1. Hepatic Hemodynamic Laboratory and Liver Transplantation Section, Barcelona, Spain
    2. Network Center for Biomedical Research in Hepatic and Digestive Diseases (CIBERehd), Barcelona, Spain
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  • Juan-Carlos García-Valdecasas,

    1. Department of Surgery, Hospital Clinic, August Pi i Sunyer Institute for Biomedical Research, University of Barcelona, Barcelona, Spain
    2. Network Center for Biomedical Research in Hepatic and Digestive Diseases (CIBERehd), Barcelona, Spain
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  • Miguel Navasa,

    1. Hepatic Hemodynamic Laboratory and Liver Transplantation Section, Barcelona, Spain
    2. Network Center for Biomedical Research in Hepatic and Digestive Diseases (CIBERehd), Barcelona, Spain
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  • Juan-Carlos García-Pagán,

    1. Hepatic Hemodynamic Laboratory and Liver Transplantation Section, Barcelona, Spain
    2. Network Center for Biomedical Research in Hepatic and Digestive Diseases (CIBERehd), Barcelona, Spain
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  • Jaime Bosch

    Corresponding author
    1. Network Center for Biomedical Research in Hepatic and Digestive Diseases (CIBERehd), Barcelona, Spain
    • Hepatic Hemodynamic Laboratory and Liver Transplantation Section, Barcelona, Spain
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  • This work was supported in part by grants from the Carlos III Institute of Health (Health Research Fund grants 06/0623 and 09/1261). The Network Center for Biomedical Research in Hepatic and Digestive Diseases (CIBERehd) is funded by the Carlos III Institute of Health.

Address reprint requests to Jaime Bosch, M.D., Ph.D., F.R.C.P., Hepatic Hemodynamic Laboratory and Liver Transplantation Section, Hospital Clinic, August Pi i Sunyer Institute for Biomedical Research, University of Barcelona, c/Villarroel 170, 08036 Barcelona, Spain. Telephone: +34 93 227 54 00, extension 5790; FAX: +34 93 227 93 48; E-mail: jbosch@clinic.ub.es

Abstract

Cirrhosis recurrence is frequent after orthotopic liver transplantation for hepatitis C virus (HCV). Because transplantation causes liver denervation, we hypothesized that the response to propranolol might differ in transplant patients versus nontransplant patients with cirrhosis and portal hypertension. Twenty-one patients with cirrhosis recurrence after orthotopic liver transplantation with portal hypertension were compared to 20 nontransplant patients with cirrhosis, HCV, and portal hypertension, and they were matched by sex, age, presence of varices, and Child-Pugh score. The patients underwent systemic and hepatic hemodynamic measurements at the baseline and 20 minutes after intravenous propranolol (0.15 mg/kg). At the baseline, the transplant patients with cirrhosis had a lower hepatic venous pressure gradient (HVPG) than the nontransplant patients with cirrhosis (14.8 ± 2.9 versus 17.3 ± 4.4 mm Hg, P = 0.03) but a higher mean arterial pressure (MAP; 100.3 ± 12.3 versus 91.8 ± 11.6 mm Hg, P = 0.04) and higher systemic vascular resistance (2253 ± 573 versus 1883 ± 525 dyn/second/cm−5, P = 0.03). There were no differences in the cardiac index (CI). Propranolol significantly decreased HVPG to similar extents in transplant patients and nontransplant patients with cirrhosis (−14.1% ± 8.0% versus −16.9% ± 9.5%, P > 0.99). MAP tended to increase in transplant patients with cirrhosis, whereas it slightly decreased in nontransplant patients (5.1% ± 14.2% versus −4.8% ± 6.4%, P = 0.007); however, the reduction in CI was less marked in transplant patients with cirrhosis (−18.6% ± 7.6% versus −26.9% ± 9.0%, P = 0.005). In conclusion, patients with HCV-related cirrhosis and portal hypertension after orthotopic liver transplantation have lower baseline HVPG values but similar HVPG responses to propranolol infusions in comparison with nontransplant patients with cirrhosis. In contrast to nontransplant patients, propranolol increases the systemic vascular resistance and arterial pressure in transplant patients with cirrhosis and attenuates the fall in CI. Liver Transpl 19:450–456, 2013. © 2013 AASLD.

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