Hipertensão arterial sistemática pós-transplante renal: fatores associados à sua prevalência e impacto na sobrevida do enxerto

Abstract

Hypertension is a frequent complication after renal transplantation in children and in adults and is a significant risk factor for the development of cardiovascular disease and graft dysfunction. The prevalence of hypertension in this population varies from 40% to 90%. Multiple mechanisms are responsible for the development of post-transplant hypertension. Renal artery stenosis, immunosuppressive drugs, allograft rejection, retained native kidneys and excessive extracellular fluid volume may all contribute to post-transplant hypertension. The high incidence of cardiovascular disease after renal transplantation is related to a high prevalence and accumulation of risk factors before and after transplantation. Hypertension, post-transplant diabetes mellitus, hyperlipidemia, obesity are well recognized risk factors for the development of cardiovascular events after renal transplantation and are also associated with the immunosuppressive therapy. Because post-renal transplant hypertension is often multifactorial in origin, it is not surprising that the use of combined antihypertensives is often necessary. The aim of this work was to examine the prevalence of post-transplant hypertension and its influence on kidney allograft survival. We reviewed patients who underwent transplantation between October 1, 1975, and December 31, 1994, at Hospital Pedro Ernesto, Rio de Janeiro - Brazil, a university hospital. A total of 322 patients aged between 3,74 and 67,9 years at renal transplantation, and whose allograft was functioning for a minimum of six months, were retrospectvely analysed, at yearly intervals after transplantation. Patients were separeted in three groups according to post-transplant blood pressure: normotensive, controlled hypertension and non-controlled hypertension. The main variables studied were: primary renal disease, gender, race, pre-transplant treatment, age at transplantation, donor type, immunosuppressive regime, pre and post- transplantat body mass Index, allograft rejection and proteinuria.