Elsevier

Journal of Hepatology

Volume 25, Issue 5, November 1996, Pages 700-706
Journal of Hepatology

Changes in plasma endothelin-1 and Big endothelin-1 induced by transjugular intrahepatic portosystemic shunts in patients with cirrhosis and refractory ascites

https://doi.org/10.1016/S0168-8278(96)80241-8Get rights and content

Abstract

Background/Aims: Endothelin-1 (ET-1) is a potent vasoconstrictor that may be involved in the pathogenesis of splanchnic and renal hemodynamic changes associated with portal hypertension. The aim of this study was to measure the concentration of ET-1 and of its precursor Big endothelin-1 (Big ET-1) in the systemic circulation as well as in the splanchnic and renal venous beds and to evaluate changes after the relief of portal hypertension following transjugular intraheptic portosystemic shunt placement.

Methods: Plasma concentrations of ET-1 and of Big ET-1 were measured in the vena cava, renal vein, hepatic vein and portal vein in ten patients with cirrhosis and refractory ascites before and 1–2 months after transjugular intrahepatic portosystemic shunt. The porto-caval gradient, creatinine clearance, plasma aldosterone and renin activity, as well as daily urinary sodium excretion were measured at the same time.

Results: The plasma concentration of ET-1 and Big ET-1, respectively, in peripheral blood of normal volunteers were 0.28±03 and 3.95±0.34 pg/ml; the concentrations of both peptides were higher in patients with cirrhosis, both in vena cava (0.61±0.14 and 10.01±1.47 pg/ml), hepatic vein (0.62±0.13 and 13.93±1.77 pg/ml), portal vein (1.21±0.12 and 17.84±1.98 pg/ml) and renal vein (0.76±0.12 and 14.21±1.55 pg/ml). Moreover ET-1 and Big ET-1 concentrations were more elevated in the portal vein that in the vena cava (+98% and +70%) and slightly higher in the renal vein as compared to the vena cava (+25% and +42%). After transjugular intrahepatic portosystemic shunt, a rise in creatinine clearance and urinary sodium excretion (+49%; and +53%) was observed together with a marked reduction in plasma aldosterone and renin activity (−59% and −49%). ET-1 and Big ET-1 concentrations remained unchanged in the vena cava whereas a significant reduction of ET-1 and Big ET-1 occured both in the portal vein (−43% and − 44%) and in the renal vein (−53% and −29%). Portal vein and renal vein concentrations of both peptides became similar to vena cava levels.

Conclusions: Splanchnic and renal hemodynamic changes occurring in patients with cirrhosis and refractory ascites could be related to the production of ET-1 by splanchnic and renal vascular beds. This was abolished by transjugular intrahepatic portosystemic shunt, which could explain the exacerbation of systemic vasodilation and the improvement in renal perfusion observed after the procedure.

References (32)

  • A Bomzon et al.

    The nitric oxide and the hyperdynamic circulation in cirrhosis

    Hepatology

    (1994)
  • M Hartleb et al.

    Relationship between plasma endothelin concentrations and the severity of cirrhosis

    Gastroenterol Clin Biol

    (1994)
  • H Isobe et al.

    Increased plasma endothelin-1 levels in patients with cirrhosis and esophageal varices

    J Clin Gastroenterol

    (1993)
  • K Moore et al.

    Plasma endothelin immunoreactivity in liver disease and the hepatorenal syndrome

    N Engl J Med

    (1992)
  • M Uchihara et al.

    Clinical significance of elevated plasma endothelin concentration in patients with cirrhosis

    Hepatology

    (1992)
  • J Uemasa et al.

    Increased plasma endothelin levels in patients with liver cirrhosis

    Nephron

    (1992)
  • Cited by (0)

    View full text