Canzanello V J, Textor S C, Taler S J, Schwartz L L, Porayko M K, Wiesner R H, Krom R A
Department of Medicine, Mayo Clinic, Rochester, MN, USA.
Liver Transpl Surg. 1998 Jul;4(4):328-34. doi: 10.1002/lt.500040404.
Hypertension frequently develops early after liver transplantation when cyclosporine-based immunosuppression is used. However, initial experience with tacrolimus has suggested that its use leads to a lower early incidence of hypertension. In this study, the blood pressure status of patients treated with cyclosporine (n = 131) and those treated with tacrolimus (n = 28) was compared 24 months after liver transplantation. At this time interval, the prevalence of hypertension in the cyclosporine and tacrolimus groups were 82% and 64%, respectively (P < .05). For those patients who were hypertensive by 24 months, onset was delayed in the tacrolimus group compared with the cyclosporine group: 40% versus 71% and 73% versus 93% at 1 and 12 months, respectively (P < .05). Within the cyclosporine group, patients with hypertension were heavier than those with normal blood pressure, 84.7 +/- 1.8 versus 73.4 +/- 4.0 kg, respectively (P < .05). Within the tacrolimus group, hypertensive patients had lower glomerular filtration rates and higher renal vascular resistances compared with normotensive patients, 74 +/- 12 versus 47 +/- 6 mL/min and 15,711 +/- 2,445 versus 28,830 +/- 4,310 dyne/s/cm5/m2, respectively (P < .05). There were no within-group differences for age, gender, pretransplant history of hypertension, family history of hypertension, graft function, or daily doses of prednisone, cyclosporine, or tacrolimus. These results indicate that, compared with cyclosporine, the onset of hypertension after liver transplantation is delayed and less prevalent with tacrolimus. Additionally, hypertension is associated with increased body weight in cyclosporine-treated patients and with more severe renal dysfunction in patients receiving tacrolimus. The relationships of these findings to the development of posttransplant hypertension requires further study.
在使用基于环孢素的免疫抑制疗法时，肝移植后早期常常会出现高血压。然而，他克莫司的初步使用经验表明，其应用可降低高血压的早期发病率。在本研究中，对肝移植24个月后接受环孢素治疗的患者（n = 131）和接受他克莫司治疗的患者（n = 28）的血压状况进行了比较。在此时间间隔时，环孢素组和他克莫司组的高血压患病率分别为82%和64%（P <.05）。对于在24个月时患高血压的患者，他克莫司组的发病时间比环孢素组延迟：在1个月和12个月时分别为40%对71%以及73%对93%（P <.05）。在环孢素组内，高血压患者比血压正常的患者体重更重，分别为84.7±1.8千克和73.4±4.0千克（P <.05）。在他克莫司组内，与血压正常的患者相比，高血压患者的肾小球滤过率更低，肾血管阻力更高，分别为74±12对47±6毫升/分钟以及15,711±2,445对28,830±4,310达因/秒/平方厘米/平方米（P <.05）。在年龄、性别、移植前高血压病史、高血压家族史、移植物功能或泼尼松、环孢素或他克莫司的每日剂量方面，组内无差异。这些结果表明，与环孢素相比，肝移植后他克莫司所致高血压的发病时间延迟且患病率更低。此外，在接受环孢素治疗的患者中，高血压与体重增加相关，而在接受他克莫司治疗的患者中，高血压与更严重的肾功能不全相关。这些发现与移植后高血压发生之间的关系需要进一步研究。
