Kaul A, Sharma R K, Gupta A, Singh U
Department of Nephrology & Biostatistics, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow.
J Assoc Physicians India. 2010 Apr;58:221-4.
Elucidate the incidence and causes of post transplant hypertension in our transplant population.
All patients transplanted between June 1989 Dec 2002 who had a functioning graft of 6 months post transplant were studied. Hypertension was defined as Systolic BP > or = 140 mmHg/Diastolic BP > or = 90 mmHg/usage of antihypertensive medication. Donor and recepient characteristics were recorded and compared. 86.2% (485) were hypertensive in post renal transplant period.
Age > or = 40 years, male sex, graft dysfunction, use of calcineurin inhibitors, high doses of steroids, chronic rejection were statistically significant correlate of post RTHT in univariate analysis. On multivariate analysis, age > or = 40 yrs (RR 2.06, 95% CI, 1.20-3.54), use of cyclosporine (RR 2.70, 95% CI, 1.54-4.75), usage of high doses of steroids (RR 2.56, 95% CI, 1.31-4.98) only were associated with post transplant hypertension. The patient and graft survival was inferior in patients with post transplant hypertension. The systolic BP at 12 months, diastolic BP at 6 months and 12 months post transplant, had significant detrimental effect on renal allografts survival.
Diagnosis, identification of risk factors and aggressive treatment of post transplant HT and of the various modifiable risk factors is important for improving renal allograft and patient survival.
阐明我们移植人群中移植后高血压的发生率及病因。
对1989年6月至2002年12月间接受移植且移植后6个月移植物功能良好的所有患者进行研究。高血压定义为收缩压≥140mmHg/舒张压≥90mmHg/使用抗高血压药物。记录并比较供体和受体的特征。86.2%（485例）在肾移植后出现高血压。
在单因素分析中，年龄≥40岁、男性、移植物功能障碍、使用钙调神经磷酸酶抑制剂、高剂量类固醇、慢性排斥反应与移植后高血压有统计学意义的相关性。在多因素分析中，仅年龄≥40岁（相对危险度2.06，95%可信区间，1.20 - 3.54）、使用环孢素（相对危险度2.70，95%可信区间，1.54 - 4.75）、使用高剂量类固醇（相对危险度2.56，95%可信区间，1.31 - 4.98）与移植后高血压相关。移植后高血压患者的患者和移植物存活率较低。移植后12个月的收缩压、6个月和12个月的舒张压对同种异体肾移植物存活有显著不利影响。
对移植后高血压及其各种可改变的危险因素进行诊断、识别危险因素并积极治疗，对于提高同种异体肾移植物和患者的存活率很重要。
