Early immunologic and nonimmunologic predictors of arterial hypertension after renal transplantation

We followed up a cohort of 680 renal transplant recipients receiving cyclos porine (CsA) immunosuppression with the aim of establishing an early-risk p rofile for early and late hypertension (HT) after renal transplantation (RT x), specifically comparing the predictive role of immunologic and nonimmuno logic markers of graft prognosis. HT was defined as the need for antihypert ensive drugs, The prevalence of HT was 65% at the time of RTx, increased to a peak of 78% at the end of the first year, and stabilized between 71% and 73% thereafter. Multivariate analysis identified HT at the time of RTx, ba sal renal disease, and grafting the right kidney as independent predictors of HT 3 months after RTx, The risk profile for HT 12 months after RTx inclu ded HT present at RTx, grafting the right kidney, markers of early ischemia -reperfusion injury (delayed graft function, cold and warm ischemia), and t ransplant from an elderly or female donor, Polytransfusion before RTx was a ssociated with a decreased risk for HT, but retransplantation, increased re activity against the lymphocyte panel, poor HLA compatibility, and early ac ute rejection did not portend an increased risk for the complication under study, The CsA schedule (dose, trough levels) correlated poorly with the bl ood pressure status of the patients, but simultaneous graft function was in dependently associated with late HT. In conclusion, the early predictive pr ofile for HT after RTx includes, preferentially, nonimmunologic markers of graft prognosis. Hyperfiltration damage may be a significant pathogenic mec hanism for this complication of RTx. (C) 1999 by the National Kidney Founda tion, Inc.