Hypertension following renal transplantation. Causative factors and therapeutic implications

During a five-year period, we studied 21 of 319 renal transplant recipients who were admitted for evaluation of refractory hypertension. For comparison we examined 93 consecutive patients in the renal transplant clinic. Hypertension, which was noted in 47% of the outpatients, occurred with greater frequency following renal transplantation from cadaveric donors and was associated with a decline in renal function. The 21 inpatients had higher blood pressures and were studied at an earlier stage than their outpatient counterparts. Fourteen of the inpatients had underlying stenosis of their transplant artery and revascularization of the transplanted kidney was possible in the majority of these patients. Stenosis of the transplant artery was suggested by the occurrence of severe hypertension during the first year following transplantation, a bruit in the transplant region, and increased levels of peripheral plasma renin activity.