Elevated blood pressure predicts the risk of acute rejection in renal allograft recipients.
Elevated blood pressure predicts the risk of acute rejection in renal allograft recipients.
复制标题
血压升高预示同种异体肾移植受者发生急性排斥反应的风险。
DOI：
10.1046/j.1523-1755.2001.0590031158.x
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发表时间：
2001
期刊：
影响因子：
--
通讯作者：
Lemeshow,S
中科院分区：
文献类型：
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作者：
Cosio,FG;Pelletier,RP;Pesavento,TE;Henry,ML;Ferguson,RM;Mitchell,L;Lemeshow,S
血压升高预示着肾移植受者发生急性排斥反应的风险。背景急性排斥反应(AR)是肾移植存活的有力预测因素。免疫抑制的最新进展大大降低了AR的发生率。尽管如此，大约25%的患者在移植后早期就发生了AR，并且易患AR的因素还没有完全弄清楚。方法本研究包括1641名成人，接受第一具身体(CAD，N=1195)或活体亲属肾移植(LRD，N=446)，在一家机构移植。结果通过单因素分析，AR与以下变量有关：较年轻(P<；0.001)；较重(P=0.003)；非裔美国人(P=0.002)；冠状动脉移植(P=0.001)；较多的人类白细胞抗原不匹配(P=0.001)；移植肾功能延迟(P=0.001)；移植后血肌酐水平较高(P=0.003)；以及移植后较高水平的收缩和/或舒张压(P<；0.001)。较高的血压水平也与较早的AR发作有关(P<；0.0001)。多变量分析显示，AR与受者年龄、HLA错配数目、DGF、PRA前状态和收缩压显著相关。对移植后每周测量的血压的分析表明，即使在AR发作前三周，血压水平升高也与AR显著相关。对于每一水平的BP，使用BP药物与较低的AR发生率相关(P<；0.0001)。此外，钙通道阻滞剂的使用也与AR的低发生率相关(P=0.001)。值得注意的是，移植后血压升高的受者中有81%患有AR。相反，移植后血压下降的患者中有22%患有AR。结论移植后血压水平升高的患者具有AR的高风险，独立于移植物功能。BP的治疗和BP水平的降低似乎与AR风险的降低有关。我们假设，高血压可能是一种特殊类型的移植物损伤的指标，可能是缺血性的，可能是易患AR的。
Elevated blood pressure predicts the risk of acute rejection in renal allograft recipients.BackgroundAcute rejection (AR) is a strong predictor of renal allograft survival. Recent advances in immunosuppression have reduced considerably the incidence of AR. Still, approximately 25% of patients have AR early post-transplant, and the factors that predispose to AR have not been fully clarified.MethodsThe study includes 1641 adults, recipients of first cadaveric (CAD,N= 1195) or living related renal grafts (LRD,N= 446), transplanted in one institution. The variables associated with the occurrence of AR during the first year post-transplant were identified.ResultsBy univariate analyses, AR was associated with the following variables: younger (P< 0.001); heavier (P= 0.003); and African American recipients (P= 0.002); CAD transplants (P= 0.001); higher number of HLA mismatches (P= 0.001); delayed graft function (DGF,P= 0.001); higher levels of serum creatinine post-transplant (P= 0.003); and higher levels of systolic and/or diastolic blood pressure (BP) post-transplant (P< 0.001). Higher BP levels were also associated with earlier AR episodes (P< 0.0001). By multivariable analysis AR was significantly associated with recipient age, number of HLA mismatches, DGF, pre-PRA and systolic BP. Analysis of BP measured weekly post-transplant indicated that elevated BP levels, even three weeks prior to the AR episode, were significantly associated with AR. For every level of BP, the use of BP medications was associated with a lower incidence of AR (P< 0.0001). Furthermore, the use of calcium channel blockers was also associated with lower incidence of AR (P= 0.001). Of note, 81% of recipients whose BP increased after the transplant had AR. In contrast, 22% of patients whose BP declined post-transplant had AR.ConclusionsElevated BP levels post-transplant identify patients at high risk of AR independently of graft function. Treatment of BP and reduction of BP levels appears to be associated with a decreased risk of AR. We hypothesize that high BP may be an indicator of a particular type of allograft damage, perhaps ischemic, that may predispose to AR.