Abstract | BACKGROUND: Orthotopic heart transplantation may interrupt key neural and humoral homeostatic mechanisms that normally adjust Na+ and fluid excretion to changes in intake. Such an interruption could lead to plasma volume expansion. METHODS: RESULTS: Supine resting plasma renin activity, angiotensin II, and aldosterone ( renin- angiotensin- aldosterone axis) and vasopressin levels were not different among the control, heart transplant, and liver transplant groups. However, there was a trend toward elevated angiotensin II (p < or = 0.08) and aldosterone (p < or = 0.08) levels in the heart transplant recipients. Atrial natriuretic peptide levels were significantly elevated two to threefold in the heart transplant recipients when compared with those in the two control groups. Blood volume, normalized for body weight (milliliters per kilogram), was significantly greater (14%) in the heart transplant recipients when compared with that in liver transplant recipients and normal healthy control subjects. Blood volume values did not differ (p > or = 0.05) between the two control groups. CONCLUSIONS: Extracellular fluid volume expansion (+14%) occurs in clinically stable heart transplant recipients who become hypertensive. Although hyperactivity of the renin- angiotensin- aldosterone axis is not apparent during supine resting conditions, our data suggest that the renin-angiotensin-aldosterone system is not responsive to a hypervolemic stimulus and this is likely a consequence of chronic cardiac deafferentation. Thus, poor adaptation of the renin-angiotensin-aldosterone system to fluid retention may be partly responsible for the incidence and severity of posttransplantation hypertension in some heart transplant recipients.
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Authors | R W Braith, R M Mills Jr, C S Wilcox, V A Convertino, G L Davis, M C Limacher, C E Wood |
Journal | The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation
(J Heart Lung Transplant)
Vol. 15
Issue 9
Pg. 872-80
(Sep 1996)
ISSN: 1053-2498 [Print] United States |
PMID | 8889982
(Publication Type: Journal Article, Research Support, Non-U.S. Gov't, Research Support, U.S. Gov't, P.H.S.)
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Chemical References |
- Electrolytes
- Hormones
- Vasopressins
- Angiotensin II
- Aldosterone
- Atrial Natriuretic Factor
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Topics |
- Aged
- Aldosterone
(blood)
- Angiotensin II
(blood)
- Atrial Natriuretic Factor
(blood)
- Denervation
(adverse effects)
- Electrolytes
(blood)
- Female
- Heart
(innervation)
- Heart Transplantation
(adverse effects)
- Hemodynamics
- Hormones
(blood)
- Humans
- Hypertension
(etiology)
- Liver Transplantation
(adverse effects)
- Male
- Middle Aged
- Neurosecretory Systems
(physiopathology)
- Plasma Volume
- Vasopressins
(blood)
- Ventricular Function, Left
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