Textor S C, Schwartz L, Canzanello V J, Wiesner R, Taler S J, Porayko M, Wilson D J, Krom R, Burnett J C, Romero J C
Department of Medicine, Mayo Clinic, Rochester, MN 55905.
J Am Soc Nephrol. 1994 Nov;5(5):1223-30. doi: 10.1681/ASN.V551223.
Hypertension developing after transplantation is characterized by widespread vasoconstriction including the kidney. Late resolution (mean, 29 +/- 4 months) of posttransplant hypertension has been observed in 15 (Group I) of 278 subjects monitored after liver transplantation. These studies were undertaken to define the systemic and renal changes associated with resolution, as compared with a group matched for age, sex, and time after transplant who remained hypertensive (Group II; N = 15) or a group who never developed hypertension (Group III; N = 23). Blood pressure during resolution paralleled changes in the systemic resistance index, which fell from 3,052 +/- 548 to 1,872 +/- 205 dyne/s.cm5/m2 (P < 0.01). GFR and RBF remained low, despite the resolution of hypertension, and renal vascular resistance did not change. Circulating endothelin levels remained above normal in all transplant recipients (Group I, 11.9 +/- 3.0 versus normal subjects, 7.0 +/- 1.1 pg/mL; P < 0.05), and urinary prostacyclin excretion was suppressed (880 +/- 120 versus 2,247 +/- 187 ng/day; P < 0.01). No hormonal differences were apparent between transplant groups. These results demonstrate the capacity for systemic vasodilation to occur after transplantation, independent of vascular tone in the kidney. They further suggest that renal vasoconstriction and impaired GFR alone are not sufficient to explain de novo hypertension after transplantation.
移植后发生的高血压的特点是包括肾脏在内的广泛血管收缩。在278例肝移植后接受监测的受试者中，有15例（I组）观察到移植后高血压的晚期缓解（平均29±4个月）。进行这些研究是为了确定与缓解相关的全身和肾脏变化，并与年龄、性别和移植后时间匹配但仍患有高血压的组（II组；N = 15）或从未发生高血压的组（III组；N = 23）进行比较。缓解期间的血压与全身阻力指数的变化平行，全身阻力指数从3,052±548降至1,872±205达因/秒·厘米⁵/平方米（P < 0.01）。尽管高血压得到缓解，但肾小球滤过率（GFR）和肾血流量（RBF）仍然较低，且肾血管阻力没有变化。所有移植受者的循环内皮素水平均高于正常水平（I组，11.9±3.0皮克/毫升，而正常受试者为7.0±1.1皮克/毫升；P < 0.05），尿前列环素排泄受到抑制（880±120纳克/天，而正常为2,247±187纳克/天；P < 0.01）。移植组之间没有明显的激素差异。这些结果表明移植后能够发生全身血管舒张，且独立于肾脏的血管张力。它们进一步表明，单纯的肾血管收缩和GFR受损不足以解释移植后新发的高血压。
