Department of Nephrology, University of Heidelberg, Heidelberg, Germany.
Department of Transplantation Immunology, University of Heidelberg, Heidelberg, Germany.
Transplantation. 2018 May;102(5):845-852. doi: 10.1097/TP.0000000000002023.
Chronic kidney disease is common after heart or liver transplantation, with calcineurin inhibitors (CNI) considered the key contributor. A possible influence of posttransplant blood pressure has not been extensively examined.
Data from adult recipients of a first heart or liver transplant were analyzed regarding the relationship between blood pressure at year 1, renal function at year 5, and CNI therapy.
Although we confirmed the well-known detrimental effect of increased 1-year systolic blood pressure on 5-year kidney graft survival, heart or liver graft survival was not affected. However, among 2534 heart transplant recipients with good renal function at year 1, increasing systolic blood pressure at year 1 was associated with higher rates of poor renal function at year 5 posttransplant. This association was confirmed on multivariate analysis overall (odds ratio, 1.25 per 20 mm Hg increment; P < 0.001) and within subgroups. Similar results were observed in 1822 liver transplant recipients (odds ratio, 1.35; P < 0.001). Neither the type of CNI nor CNI dose or trough level at year 1 showed a significant association with kidney function at year 5.
One-year blood pressure was identified as the major modifiable risk factor associated with deteriorating kidney function between years 1 and 5 after heart or liver transplantation.
慢性肾脏病在心脏或肝脏移植后很常见，钙调磷酸酶抑制剂（CNI）被认为是主要的致病因素。但移植后血压的可能影响尚未得到广泛研究。
对首次心脏或肝脏移植的成年受者的数据进行了分析，研究了第 1 年的血压、第 5 年的肾功能和 CNI 治疗之间的关系。
尽管我们证实了 1 年时收缩压升高对 5 年肾移植物存活率的不良影响，但心脏或肝脏移植物存活率未受影响。然而，在 2534 例第 1 年肾功能良好的心脏移植受者中，第 1 年收缩压升高与移植后第 5 年肾功能不良的发生率升高相关。总体而言，该相关性在多变量分析中得到了证实（比值比，每 20mmHg 增加 1.25；P<0.001），并且在亚组中也得到了证实。在 1822 例肝移植受者中也观察到了类似的结果（比值比，1.35；P<0.001）。第 1 年的 CNI 类型、CNI 剂量或谷值水平与第 5 年的肾功能均无显著相关性。
1 年时的血压被确定为心脏或肝脏移植后第 1 年至第 5 年之间肾功能恶化的主要可改变危险因素。
