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Propranolol improves endothelial dysfunction in advanced cirrhosis: the ‘endothelial exhaustion’ hypothesis
  1. Anderson Brito-Azevedo1,2,
  2. Renata de Mello Perez1,3,
  3. Henrique Sérgio Moraes Coelho1,
  4. Eduardo de Souza Martins Fernandes2,4,
  5. Raquel Carvalho Castiglione5,
  6. Cristiane Alves Villela-Nogueira1,
  7. Eliete Bouskela5
  1. 1Division of Hepatology, Department of Internal Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
  2. 2Liver Transplant Unit, Adventista Silvestre Hospital, Rio de Janeiro, RJ, Brazil
  3. 3Department of Gastroenterology, State University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
  4. 4Departament of Surgery, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
  5. 5Laboratory for Clinical and Experimental Research on Vascular Biology (BioVasc), State University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
  1. Correspondence to Dr Anderson Brito de Azevedo Silva, Division of Hepatology, Internal Medicine Department, Federal University of Rio de Janeiro. Avenida Professor Rodolpho Paulo Rocco, 255, Rio de Janeiro, RJ 21941-913, Brazil; andersonbrito.a{at}gmail.com

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We read with interest the recent work of Leithead and coworkers about the use of non-selective β-blockers (NSBBs) in patients in the transplant waiting list. They studied 322 patients, among those 117 had refractory ascites and observed higher survival rate in those using NSBB, including the ones with refractory ascites (HR mortality=0.35; confidence interval (CI) 95%: 0.14 to 0.86).1 However, the use of NSBB has been a polemic issue since the hypothesis proposed by Krag and coworkers suggesting the existence of a ‘therapeutic window’, according to which NSBB would not be beneficial to patients in early or end-stage cirrhosis with refractory ascites, when it would impair the compensatory cardiac output increase, worsening organ perfusion in decompensated cirrhosis.2

Considering current controversies about the use of propranolol (PPL) in advanced cirrhosis, and its possible deleterious effect on haemodynamic and organ perfusion, we have investigated the endothelial function in patients with …

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