Canzanello V J, Schwartz L, Taler S J, Textor S C, Wiesner R H, Porayko M K, Krom R A
Department of Medicine (Division of Hypertension and Internal Medicine), Mayo Clinic, Rochester, MN 55905, USA.
Liver Transpl Surg. 1997 Jan;3(1):1-9. doi: 10.1002/lt.500030101.
The development of atherosclerotic cardiovascular complications is a common and serious problem for the long-term survivors of organ transplantation. Cyclosporine A plus steroid-based immuno-suppression regimens in these patients are associated with the development of hypertension, hyperlipidemia, obesity, and diabetes mellitus. Whether the new immunosuppressive agent tacrolimus (FK506) confers any advantage in terms of these cardiovascular risk factors has been less well studied. We compared serial changes in blood pressure, lipids, body weight, and glucose levels during the first 12 months after liver transplantation in patients using either cyclosporine A (n = 39) or tacrolimus (n = 24)-based immunosuppression. By 12 months, the prevalence of hypertension, hypercholesterolemia, and obesity was increased in the cyclosporine A group compared to tacrolimus: 82% versus 33%, 33% versus 0%, and 46% versus 29%, respectively (all p < .05). Triglyceride and total cholesterol levels were 196 +/- 23 versus 125 +/- 13 mg/dL and 225 +/- 9 versus 159 +/- 7 mg/dL for the cyclosporine A versus tacrolimus groups, respectively (p < .05). Cumulative posttransplant steroid dose was not related to the observed lipid changes in either group, although the increase in triglycerides was positively correlated to weight gain and diuretic use in the cyclosporine A group. The incidence of diabetes mellitus was not increased from baseline in either group. These results indicate that tacrolimus, compared to cyclosporine A, is associated with a less adverse cardiovascular risk profile in the first year after liver transplantation. Whether these differences persist and become clinically relevant to a liver transplant recipient population that is increasingly older and has more preexisting cardiovascular disease remains to be determined.
动脉粥样硬化性心血管并发症的发生是器官移植长期存活者面临的常见且严重的问题。这些患者采用环孢素A加类固醇的免疫抑制方案与高血压、高脂血症、肥胖症和糖尿病的发生有关。新型免疫抑制剂他克莫司（FK506）在这些心血管危险因素方面是否具有任何优势，目前研究较少。我们比较了使用环孢素A（n = 39）或他克莫司（n = 24）进行免疫抑制的肝移植患者在术后12个月内血压、血脂、体重和血糖水平的系列变化。到12个月时，与他克莫司组相比，环孢素A组高血压、高胆固醇血症和肥胖症的患病率增加：分别为82%对33%、33%对0%、46%对29%（所有p < 0.05）。环孢素A组与他克莫司组的甘油三酯和总胆固醇水平分别为196±23对125±13 mg/dL和225±9对159±7 mg/dL（p < 0.05）。尽管环孢素A组甘油三酯的升高与体重增加和利尿剂的使用呈正相关，但两组中移植后类固醇的累积剂量均与观察到的脂质变化无关。两组糖尿病的发病率均未从基线水平增加。这些结果表明，与环孢素A相比，他克莫司在肝移植后的第一年与较低的不良心血管风险特征相关。这些差异是否持续存在并对年龄越来越大且已有更多心血管疾病的肝移植受者群体具有临床相关性，仍有待确定。
