Overall, the risk of coronary artery disease posttransplant is three- to fivefold that for age- and sex-matched control subjects. Risk factors for coronary artery disease include (1) pretransplant coronary artery disease, (2) hyperlipidemia secondary to antirejection medications, (3) hypertension, (4) steroids, (5) insulin-dependent diabetes mellitus, (6) erythrocytosis with increased blood viscosity, (7) smoking, and (8) frequent rejection episodes. 21
Hypertension is found in approximately 50 percent of all transplant patients. Possible causes of hypertension include (1) graft rejection, (2) CYA toxicity, (3) glomerulonephritis (recurrent and de novo), (4) graft renal artery stenosis, (5) essential hypertension from native kidneys, (6) hypercalcemia, and (7) steroids. 22 Calcium channel blockers (CCB) have been shown to be particularly efficacious in treating hypertension in renal transplant patients on CYA, although CCBs interfere with CYA metabolism.
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