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Mechanisms of hypertension during and after orthotopic liver transplantation in children

Lawless, S and Ellis, D and Thompson, A and Cook, DR and Esquivel, C and Starzl, T (1989) Mechanisms of hypertension during and after orthotopic liver transplantation in children. The Journal of Pediatrics, 115 (3). 372 - 379. ISSN 0022-3476

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The aim of this study was to assess the hormonal alterations that may mediate the systemic hypertension that develops in patients during the perioperative period of orthotopic liver transplantation. We studied nine pediatric patients without previous hypertension or renal disease during six time points, starting before transplantation and ending at 48 hours after surgery. Hypertension developed in all patients in association with central venous pressures <10 mm Hg. Free water clearance was negative in all nine patients. Vasopressin levels increased intraoperatively but fell as hypertension developed. Atrial natriuretic factor levels increased as systemic blood pressure rose. A high level of plasma renin activity was observed in four patients with renal insufficiency. In six patients, postoperative 24-hour urinary norepinephrine excretion was within the normal age-adjusted range. These findings suggest that the combination of cyclosporine, corticosteroids, and, in some patients, an elevated plasma renin activity prevents the kidney from responding to the acute volume and salt overload with an appropriate diuresis and natriuresis, thus leading to systemic hypertension. The treatment of hypertension after liver transplantation may include salt restriction, diuretics, and, in those patients with a low creatinine excretion index, anglotensin coverting enzyme inhibitors. © 1989 The C. V. Mosby Company.


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Item Type: Article
Status: Published
CreatorsEmailPitt UsernameORCID
Lawless, S
Ellis, D
Thompson, AThompsonae@medschool.pitt.eduANT20000-0002-2549-9560
Cook, DR
Esquivel, C
Starzl, Ttes11@pitt.eduTES11
Centers: Other Centers, Institutes, Offices, or Units > Thomas E. Starzl Transplantation Institute
Date: 1 January 1989
Date Type: Publication
Journal or Publication Title: The Journal of Pediatrics
Volume: 115
Number: 3
Page Range: 372 - 379
DOI or Unique Handle: 10.1016/s0022-3476(89)80834-0
Institution: University of Pittsburgh
Refereed: Yes
ISSN: 0022-3476
Other ID: uls-drl:31735062110212, Starzl CV No. 980
Date Deposited: 08 Apr 2010 17:16
Last Modified: 05 Oct 2020 15:55


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