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Hypertension frequently develops early after liver transplantation when cyclosporine-based immunosuppression is used. However, initial experience with tacrolimus has suggested that its use leads to a lower early 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 cyclosporine and tacrolimus groups were 82% and 64%, respectively (P F .05). For those patients who were hypertensive by 24 months, onset was delayed in the tacrolimus group compared with the cyclosporine group: 40% versus 71% and 73% versus 93% at 1 and 12 months, respectively (P F .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 F .05). Within the tacrolimus group, hypertensive patients had lower glomerular filtration rates and higher renal vascular resistances compared with normotensive patients, 74 ؎ 12 versus 47 ؎ 6 mL/min and 15,711 ؎ 2,445 versus 28,830 ؎ 4,310 dyne/s/cm 5 / m 2 , respectively (P F .05). There were no withingroup differences for age, gender, pretransplant history of hypertension, family history of hypertension, graft function, or daily doses of prednisone, cyclosporine, or tacrolimus. These results indicate that, compared with cyclosporine, the onset of hypertension after liver transplantation is delayed and less prevalent with tacrolimus. Additionally, hypertension is associated with increased body weight in cyclosporine-treated patients and with more severe renal dysfunction in patients receiving tacrolimus. The relationships of these findings to the development of posttransplant hypertension requires further study. Copyright 1998 by the American Association for the Study of Liver DiseasesH ypertension frequently occurs early after liver transplantation when immunosuppression with cyclosporine plus prednisone is used, amounting to a prevalence of 75% to 85% by 24 months. 1-3 Several reports have suggested that the incidence of hypertension in patients treated with tacrolimus (also called FK 506) is lower than that in patients treated with cyclosporine within the first year or two after kidney transplantation, 4-6 up to 3 years after heart transplantation, 7-9 and during the first year after liver transplantation. [10][11][12] We have observed, however, that the prevalence of hypertension in tacrolimus-treated patients increases in the second year after liver transplantation and may approach that observed in patients treated with cyclosporine. 3 We examined the development of hypertension in patients treated with cyclosporine or tacrolimus and followed up for 24 months after liver transplantation. The goals of this study were to assess the prevalence of hypertension in these two patient groups and to compare clinical and laboratory characteristics that might be associated with the development of...

The development of atherosclerotic cardiovascular complications is a common and serious problem for the long-term survivors of organ transplantation. Cyclosporine A plus steroid-based immuno-suppression regimens in these patients are associated with the development of hypertension, hyperlipidemia, obesity, and diabetes mellitus. Whether the new immunosuppressive agent tacrolimus (FK506) confers any advantage in terms of these cardiovascular risk factors has been less well studied. We compared serial changes in blood pressure, lipids, body weight, and glucose levels during the first 12 months after liver transplantation in patients using either cyclosporine A (n = 39) or tacrolimus (n = 24)-based immunosuppression. By 12 months, the prevalence of hypertension, hypercholesterolemia, and obesity was increased in the cyclosporine A group compared to tacrolimus: 82% versus 33%, 33% versus 0%, and 46% versus 29%, respectively (all p < .05). Triglyceride and total cholesterol levels were 196 +/- 23 versus 125 +/- 13 mg/dL and 225 +/- 9 versus 159 +/- 7 mg/dL for the cyclosporine A versus tacrolimus groups, respectively (p < .05). Cumulative posttransplant steroid dose was not related to the observed lipid changes in either group, although the increase in triglycerides was positively correlated to weight gain and diuretic use in the cyclosporine A group. The incidence of diabetes mellitus was not increased from baseline in either group. These results indicate that tacrolimus, compared to cyclosporine A, is associated with a less adverse cardiovascular risk profile in the first year after liver transplantation. Whether these differences persist and become clinically relevant to a liver transplant recipient population that is increasingly older and has more preexisting cardiovascular disease remains to be determined.