Blood pressure changes and renal transplantation

Abstract

Blood pressure changes before and after renal transplantation and the factors contributing to them were studied in 72 living-related allograft recipients with a follow-up of 3 years.
Of patients on 3-times-a-week, in-hospital dialysis, 30 (42%) had hypertension and 8 (11%) hypotension. After renal transplantation, 48 (67%) developed hypertension in 3 years. The hypertensives on dialysis tended to remain so, in spite of successful renal transplantation. The incidence of hypertension was higher in those with 2 or more acute rejection episodes than in those with none or one. Twenty-one patients developed chronic rejection, and all but 3 had hypertension.
After renal transplantation, plasma renin activity (PRA) of the hypertensives was higher than that of the normotensives. Split renal vein renin activity was measured in several patients. In all, PRA from the original diseased kidneys was higher than that of the graft. Renovascular hypertension due to graft artery stenosis was seen in only one patient who required by-pass surgery.
Two-thirds of the postoperative hypertensives were well controlled with one or two anti-hypertensive drugs.
Eight patients showed hypotension on dialysis, 4 of whom had undergone bilateral nephrectomy mainly because of small renal cell carcinoma complicated with acquired cystic disease of the kidney.
Despite the development of oliguric acute renal failure in 5 of 8 patients after surgery, blood pressure returned to the normal level soon after transplantation in all patients. This process was far quicker than the recovery of uremic neuropathy, suggesting that some humoral factor (s) from the normal kiney tissue was involved.