engleski

ARTERIAL HYPERTENSION AFTER LIVER TRANSPLANTATION: A SINGLE CENTRE RESULTS

The improvement in immunosuppressive therapy resulted in increasing graft and patient survival after liver transplantation (LT). However, immunosuppressive therapy with calcineurin inhibitors such as cyclosporine (CsA) and tacrolimus (Tac) is a major cause for the development of post-transplant hypertension. The aim of this study was to retrospectively analyze the frequency of hypertension (>140/90 mmHg) in the cohort of 183 liver transplanted patients in the period from 2005 and 2009 at a single institution. Patients were divided into three groups based on immunosuppressive regimen: CsA (98 cases), Tac (79 cases) and mammalian target of rapamycine inhibitors (mTOR inhibitors) (6 cases). Steroids were tapered over a 90-day period in all groups. Mean follow-up was 21 months (range 0-53 months). A total of 103 cases (57%) developed arterial hypertension. Overall frequency of hypertension was the most pronounced in CsA group 64% (63/98), as compared to Tac group 47% (37/79) or mTOR inhibitor group 50% (3/6). Significant statistical difference was noticed between calcineurin inhibitor groups (CsA vs. Tac, p= 0, 02). Cyclosporine was associated with relative risk of hypertension of 1.39 (CI 1, 04-1, 85). Majority of hypertensive transplanted patients (49%) were taking one of the antihypertensive drugs, followed by 37%, 11% and 3% taking two, three or four antihypertensive drugs, respectively. Dominant regimens included calcium channel blocker (CCB) 53% and diuretics 27%, whereas other medications such as beta blocker 8%, angiotensin-converting enzyme inhibitors (ACEI) 7% and urapidil 6 % were used less frequently. In summary, our results demonstrate that the burden of arterial hypertension in liver transplant patients is considerable. Cyclosporine may be associated with arterial hypertension more frequently than other immunosuppressive agents. The impact of blood pressure control on long-term patient and graft outcome in liver transplant recipients remains to be determined.

arterial hypertension; liver transplantation

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