Textor Stephen C, Taler Sandra J, Driscoll Nancy, Larson Timothy S, Gloor James, Griffin Matthew, Cosio Fernando, Schwab Thomas, Prieto Mikel, Nyberg Scott, Ishitani Michael, Stegall Mark
Department of Medicine, Divisions of Nephrology and Hypertension, W9A, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
Transplantation. 2004 Jul 27;78(2):276-82. doi: 10.1097/01.tp.0000128168.97735.b3.
Rising numbers of patients reaching end-stage kidney disease intensify the demand for expansion of the living-kidney-donor pool. On the basis of low risk in white donors with essential hypertension, our transplant center undertook a structured program of accepting hypertensive donors if kidney function and urine protein were normal. This study reports outcomes of hypertensive donors 1 year after kidney donation.
We studied detailed measurements of blood pressure (oscillometric, hypertensive therapy nurse [RN], and ambulatory blood pressure monitoring [ABPM]), clinical, and renal characteristics (iothalamate glomerular filtration rate [GFR], urine protein, and microalbumin) in 148 living kidney donors before and 6 to 12 months after nephrectomy. Twenty-four were hypertensive (awake ABPM>135/85 mm Hg and clinic/RN BP>140/90 mm Hg) before donation.
After 282 days, normotensive donors had no change in awake ABPM pressure (pre 121 +/- 1/75 +/- 2 vs. post 120 +/- 1/ 5 +/- 1 mm Hg), whereas BP in hypertensive donors fell with both nonpharmacologic and drug therapy (pre 142 +/- 3/85 +/- 2 to post 132 +/- 2/80 +/- 1 mm Hg, P<.01). Hypertensive donors were older (53.4 vs. 41.4 years, P<.001) and had lower GFR after kidney donation (61 +/- 2 vs. 68 +/- 1 mL/min/1.73m, P<.01). After correction for age, no independent BP effect was evident for predicting GFR either before or after nephrectomy. Urine protein and microalbumin did not change in either group after donor nephrectomy.
Our results indicate that white subjects with moderate, essential hypertension and normal kidney function have no adverse effects regarding blood pressure, GFR, or urinary protein excretion during the first year after living kidney donation. Although further studies are essential to confirm long-term safety, these data suggest that selected hypertensive patients may be accepted for living kidney donation.
终末期肾病患者数量的不断增加，加剧了扩大活体肾供体库的需求。基于白人原发性高血压供体风险较低，我们的移植中心开展了一项结构化项目，即如果肾功能和尿蛋白正常，则接受高血压供体。本研究报告了肾移植术后1年高血压供体的情况。
我们研究了148名活体肾供体在肾切除术前及术后6至12个月的详细血压测量值（示波法、高血压治疗护士测量值及动态血压监测值）、临床及肾脏特征（碘肽葡胺肾小球滤过率、尿蛋白及微量白蛋白）。其中24名供体在捐献前患有高血压（清醒动态血压监测值>135/85 mmHg且诊所/护士测量血压>140/90 mmHg）。
282天后，血压正常的供体清醒动态血压监测值无变化（术前121±1/75±2 vs.术后120±1/75±1 mmHg），而高血压供体的血压通过非药物治疗和药物治疗均有所下降（术前142±3/85±2至术后132±2/80±1 mmHg，P<.01）。高血压供体年龄较大（53.4岁 vs. 41.4岁，P<.001），肾移植术后肾小球滤过率较低（61±2 vs. 68±1 mL/min/1.73m²，P<.01）。校正年龄后，术前或术后预测肾小球滤过率均未发现血压有独立影响。供体肾切除术后两组的尿蛋白和微量白蛋白均无变化。
我们的结果表明，患有中度原发性高血压且肾功能正常的白人受试者在活体肾移植术后第一年，血压、肾小球滤过率或尿蛋白排泄方面没有不良影响。尽管进一步研究对于确认长期安全性至关重要，但这些数据表明，特定的高血压患者可被接受进行活体肾移植。
