LATE HYPERTENSION AFTER LIVER-TRANSPLANTATION - A COMPARISON OF CYCLOSPORINE AND TACROLIMUS (FK-506)

Hypertension frequently develops early after liver transplantation whe n cyclosporine-based immunosuppression is used. However, initial exper ience with tacrolimus has suggested that its use leads to a lower earl y 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 cyclosp orine and tacrolimus groups were 82% and 64%, respectively (P <.05). F or those patients who were hypertensive by 24 months, onset was delaye d in the tacrolimus group compared with the cyclosporine group: 40% ve rsus 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, hypertensiv e patients had lower glomerular filtration rates and higher renal vasc ular resistances compared with normotensive patients, 74 +/- 12 versus 47 +/- 6 mL/min and 15,711 +/- 2,445 versus 28,830 +/- 4,310 dyne/s/c m(5)/ m(2), respectively (P <.05). There were no within-group differen ces for age, gender, pretransplant history of hypertension, family his tory of hypertension, graft function, or daily doses of prednisone, cy closporine, or tacrolimus. These results indicate that, compared with cyclosporine, the onset of hypertension after river transplantation is delayed and less prevalent with tacrolimus. Additionally, hypertensio n is associated with increased body weight In cyclosporine-treated pat ients and with more severe renal dysfunction in patients receiving tac rolimus. The relationships of these findings to the development of pos ttransplant hypertension requires further study. Copyright (C) 1998 by the American Association for the Study of Liver Diseases.