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. 1990 Nov;65(11):1217–1221. doi: 10.1136/adc.65.11.1217

Severe hypertension after liver transplantation in alpha 1 antitrypsin deficiency.

G Noble-Jamieson 1, N D Barnes 1, S Thiru 1, A P Mowat 1
PMCID: PMC1792593  PMID: 2248532

Abstract

Five children with alpha 1 antitrypsin deficiency and terminal liver disease received liver grafts; all five became hypertensive and four developed hypertensive encephalopathy. There was evidence of renal disease preoperatively and renal biopsy specimens showed variable glomerulonephritic histology with IgA nephropathy in one, mesangial-proliferative changes in two, and mesangio-capillary glomerulonephritis type I in two. Four hypertensive episodes were preceded by a fall in creatinine clearance. The association of glomerulonephritis with alpha 1 antitrypsin deficiency in children is more common than has been recognised. Affected patients are prone to severe hypertension of probable renal origin after liver transplantation and the renal lesion may affect long term prognosis.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Chesney R. W., Novello A. C. Forms of nephrotic syndrome more likely to progress to renal impairment. Pediatr Clin North Am. 1987 Jun;34(3):609–627. doi: 10.1016/s0031-3955(16)36253-8. [DOI] [PubMed] [Google Scholar]
  2. Clément de Cléty S., Moulin D., Reynaert M., Carlier M. A., Veyckmans F., de Hemptinne B., de Ville de Goyet J., Otte J. B. Postoperative care in pediatric orthotopic liver transplantation. Transplant Proc. 1987 Aug;19(4):3338–3343. [PubMed] [Google Scholar]
  3. Deierhoi M. H., Kalayoglu M., Sollinger H. W., Belzer F. O. Cyclosporine neurotoxicity in liver transplant recipients: report of three cases. Transplant Proc. 1988 Feb;20(1):116–118. [PubMed] [Google Scholar]
  4. Dillon M. J. Investigation and management of hypertension in children. A personal perspective. Pediatr Nephrol. 1987 Jan;1(1):59–68. doi: 10.1007/BF00866886. [DOI] [PubMed] [Google Scholar]
  5. Ellis D., Avner E. D., Starzl T. E. Renal failure in children with hepatic failure undergoing liver transplantation. J Pediatr. 1986 Mar;108(3):393–398. doi: 10.1016/s0022-3476(86)80879-4. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Gartner J. C., Jr, Zitelli B. J., Malatack J. J., Shaw B. W., Iwatsuki S., Starzl T. E. Orthotopic liver transplantation in children: two-year experience with 47 patients. Pediatrics. 1984 Jul;74(1):140–145. [PMC free article] [PubMed] [Google Scholar]
  7. Kahan B. D. Cyclosporine. N Engl J Med. 1989 Dec 21;321(25):1725–1738. doi: 10.1056/NEJM198912213212507. [DOI] [PubMed] [Google Scholar]
  8. Miller F., Kuschner M. Alpha1-antitrypsin deficiency, emphysema, necrotizing angiitis and glomerulonephritis. Am J Med. 1969 Apr;46(4):615–623. doi: 10.1016/0002-9343(69)90080-1. [DOI] [PubMed] [Google Scholar]
  9. Moroz S. P., Cutz E., Balfe J. W., Sass-Kortsak A. Membranoproliferative glomerulonephritis in childhood cirrhosis associated with alpha1-antitrypsin deficiency. Pediatrics. 1976 Feb;57(2):232–238. [PubMed] [Google Scholar]
  10. Nasjletti A., Erman A., Cagen L. M., Baer P. G. Plasma concentrations, renal excretion, and tissue release of prostaglandins in the rat with dexamethasone-induced hypertension. Endocrinology. 1984 Mar;114(3):1033–1040. doi: 10.1210/endo-114-3-1033. [DOI] [PubMed] [Google Scholar]
  11. Papadakis M. A., Arieff A. I. Unpredictability of clinical evaluation of renal function in cirrhosis. Prospective study. Am J Med. 1987 May;82(5):945–952. doi: 10.1016/0002-9343(87)90156-2. [DOI] [PubMed] [Google Scholar]
  12. Ramos-Frendo B., Eloy L., Grünfeld J. P. Methylprednisolone-induced hypertension in the rat: evidence against the role of plasma volume changes, vasopressin and renal prostaglandin E2. J Hypertens. 1985 Oct;3(5):461–467. [PubMed] [Google Scholar]
  13. Schneider E. G., Davis J. O., Baumber J. S., Johnson J. A. Renin, aldosterone, and hypertension. The hepatic metabolism of renin and aldosterone. A review with new observations on the hepatic clearance of renin. Circ Res. 1970 Jul;27(1 Suppl 1):175–183. [PubMed] [Google Scholar]
  14. Starzl T. E., Iwatsuki S., Shaw B. W., Jr, Gordon R. D., Esquivel C. O. Immunosuppression and other nonsurgical factors in the improved results of liver transplantation. Semin Liver Dis. 1985 Nov;5(4):334–343. doi: 10.1055/s-2008-1040630. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Starzl T. E., Iwatsuki S., Shaw B. W., Jr, Gordon R. D., Esquivel C. Liver transplantation in the ciclosporin era. Prog Allergy. 1986;38:366–394. doi: 10.1159/000318481. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Strife C. F., Hug G., Chuck G., McAdams A. J., Davis C. A., Kline J. J. Membranoproliferative glomerulonephritis and alpha 1-antitrypsin deficiency in children. Pediatrics. 1983 Jan;71(1):88–92. [PubMed] [Google Scholar]
  17. de Groen P. C., Wiesner R. H., Krom R. A. Cyclosporine A-induced side effects related to a low total serum cholesterol level: an indication for a free cyclosporine A assay? Transplant Proc. 1988 Apr;20(2 Suppl 2):374–376. [PubMed] [Google Scholar]

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