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Hypertension Following Kidney Transplantation

  • Mario F. Rubin
    Correspondence
    Address correspondence to Mario F. Rubin, MD, Division of Nephrology, Massachusetts General Hospital 165 Cambridge Street Suite 302 Boston, MA 02114.
    Affiliations
    Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, MA
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      The majority of patients become hypertensive following kidney transplantation. Its occurrence is associated not only with increased fatal and nonfatal cardiovascular events but also with decreased allograft survival. This review summarizes the current knowledge of the epidemiology, etiology, pathophysiology, and management of post-transplant hypertension.

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      References

        • Ojo A.O.
        Cardiovascular complications after renal transplantation and their prevention.
        Transplantation. 2006; 82: 603-611
        • Kasiske B.L.
        • Anjum S.
        • Shah R.
        • et al.
        Hypertension after kidney transplantation.
        Am J Kidney Dis. 2004; 43: 1071-1081
        • Gaston R.S.
        • Basadonna G.
        • Cosio F.G.
        • et al.
        Transplantation in the diabetic patient with advanced chronic kidney disease: a task force report.
        Am J Kidney Dis. 2004; 44: 529-542
      1. Special Issue: KDIGO clinical practice guideline for the care of kidney transplant recipients.
        Am J Transplant. 2009; 9: S1-S155
        • Cosio F.G.
        • Pelletier R.P.
        • Pesavento T.E.
        • et al.
        Elevated blood pressure predicts the risk of acute rejection in renal allograft recipients.
        Kidney Int. 2001; 59: 1158-1164
        • Thomas M.C.
        • Mathew T.H.
        • Russ G.R.
        • et al.
        Perioperative blood pressure control, delayed graft function, and acute rejection after renal transplantation.
        Transplantation. 2003; 75: 1989-1995
        • Weir M.R.
        Blood pressure management in the kidney transplant recipient.
        Adv Chronic Kidney Dis. 2004; 11: 172-183
        • Curtis J.J.
        • Luke R.G.
        • Dustan H.P.
        • et al.
        Remission of essential hypertension after renal transplantation.
        N Engl J Med. 1983; 309: 1009-1015
        • Curtis J.J.
        • Luke R.G.
        • Dustan H.P.
        • et al.
        Remission of essential hypertension after renal transplantation.
        J Am Soc Nephrol. 2000; 11: 2404-2412
        • Ducloux D.
        • Motte G.
        • Kribs M.
        • et al.
        Hypertension in renal transplantation: donor and recipient risk factors.
        Clin Nephrol. 2002; 57: 409-413
        • Strandgaard S.
        • Hansen U.
        Hypertension in renal allograft recipients may be conveyed by cadaveric kidneys from donors with subarachnoid haemorrhage.
        Br Med J (Clin Res Ed). 1986; 292: 1041-1044
        • Nankivell B.J.
        • Borrows R.J.
        • Fung C.L.-S.
        • et al.
        The natural history of chronic allograft nephropathy.
        N Engl J Med. 2003; 349: 2326-2333
        • Briganti E.M.
        • Russ G.R.
        • McNeil J.J.
        • et al.
        Risk of renal allograft loss from recurrent glomerulonephritis.
        N Engl J Med. 2002; 347: 103-109
        • Arias M.
        • Fernandez-Fresnedo G.
        • Rodrigo E.
        • et al.
        Non-immunologic intervention in chronic allograft nephropathy.
        Kidney Int Suppl. 2005; : S118-S123
        • Huysmans F.T.
        • Hoitsma A.J.
        • Koene R.A.
        Factors determining the prevalence of hypertension after renal transplantation.
        Nephrol Dial Transplant. 1987; 2: 34-38
        • Curtis J.J.
        • Lucas B.A.
        • Kotchen T.A.
        • et al.
        Surgical therapy for persistent hypertension after renal transplantation.
        Transplantation. 1981; 31: 125-128
        • Linas S.L.
        • Miller P.D.
        • McDonald K.M.
        • et al.
        Role of the renin-angiotensin system in post-transplantation hypertension in patients with multiple kidneys.
        N Engl J Med. 1978; 298: 1440-1444
        • Curtis J.J.
        • Luke R.G.
        • Diethelm A.G.
        • et al.
        Benefits of removal of native kidneys in hypertension after renal transplantation.
        Lancet. 1985; 2: 739-742
        • Teixeira M.C.
        • Nahas W.C.
        • Mazucchi E.
        • et al.
        Role of the peripheral renin profile in predicting blood pressure control after bilateral nephrectomy in renal-transplanted patients.
        Nephrol Dial Transplant. 1998; 13: 2092-2097
        • Luke R.G.
        • Curtis J.J.
        • Jones P.
        • et al.
        Mechanisms of post-transplant hypertension.
        Am J Kidney Dis. 1985; 5: A79-A84
        • Kasiske B.L.
        Possible causes and consequences of hypertension in stable renal transplant patients.
        Transplantation. 1987; 44: 639-643
        • Fricke L.
        • Doehn C.
        • Steinhoff J.
        • et al.
        Treatment of post-transplant hypertension by laparoscopic bilateral nephrectomy?.
        Transplantation. 1998; 65: 1182-1187
        • Fornara P.
        • Doehn C.
        • Fricke L.
        • et al.
        Laparoscopic bilateral nephrectomy: results in 11 renal transplant patients.
        J Urol. 1997; 157: 445-449
        • Fervenza F.C.
        • Lafayette R.A.
        • Alfrey E.J.
        • et al.
        Renal artery stenosis in kidney transplants.
        Am J Kidney Dis. 1998; 31: 142-148
        • Lacombe M.
        Arterial stenosis complicating renal allotransplantation in man: a study of 38 cases.
        Ann Surg. 1975; 181: 283-288
        • Hurst F.P.
        • Abbott K.C.
        • Neff R.T.
        • et al.
        Incidence, predictors and outcomes of transplant renal artery stenosis after kidney transplantation: analysis of USRDS.
        Am J Nephrol. 2009; 30: 459-467
        • Hricik D.E.
        Antihypertensive and renal effects of enalapril in post-transplant hypertension.
        Clin Nephrol. 1987; 27: 250-259
        • Lye W.C.
        • Leong S.O.
        • Lee E.J.
        Transplant renal artery stenosis presenting with recurrent acute pulmonary edema.
        Nephron. 1996; 72: 302-304
        • Merkus J.W.
        • Huysmans F.T.
        • Hoitsma A.J.
        • et al.
        Renal allograft artery stenosis: results of medical treatment and intervention. A retrospective analysis.
        Transplant Int. 1993; 6: 111-115
        • Grossman R.A.
        • Dafoe D.C.
        • Shoenfeld R.B.
        • et al.
        Percutaneous transluminal angioplasty treatment of renal transplant artery stenosis.
        Transplantation. 1982; 34: 339-343
        • Fauchald P.
        • Vatne K.
        • Paulsen D.
        • et al.
        Long-term clinical results of percutaneous transluminal angioplasty in transplant renal artery stenosis.
        Nephrol Dial Transplant. 1992; 7: 256-259
        • Sawaya B.
        • Provenzano R.
        • Kupin W.L.
        • et al.
        Cyclosporine-induced renal macroangiopathy.
        Am J Kidney Dis. 1988; 12: 534-537
        • de Morais R.H.
        • Muglia V.F.
        • Mamere A.E.
        • et al.
        Duplex Doppler sonography of transplant renal artery stenosis.
        J Clin Ultrasound. 2003; 31: 135-141
        • Erley C.M.
        • Duda S.H.
        • Wakat J.P.
        • et al.
        Noninvasive procedures for diagnosis of renovascular hypertension in renal transplant recipients—a prospective analysis.
        Transplantation. 1992; 54: 863-867
        • Geddes C.C.
        • McManus S.K.
        • Koteeswaran S.
        • et al.
        Long-term outcome of transplant renal artery stenosis managed conservatively or by radiological intervention.
        Clin Transplant. 2008; 22: 572-578
        • Greenstein S.M.
        • Verstandig A.
        • McLean G.K.
        • et al.
        Percutaneous transluminal angioplasty. The procedure of choice in the hypertensive renal allograft recipient with renal artery stenosis.
        Transplantation. 1987; 43: 29-32
        • Tilney N.L.
        • Rocha A.
        • Strom T.B.
        • et al.
        Renal artery stenosis in transplant patients.
        Ann Surg. 1984; 199: 454-460
        • Ligtenberg G.
        • Hene R.J.
        • Blankestijn P.J.
        • et al.
        Cardiovascular risk factors in renal transplant patients: cyclosporin A versus tacrolimus.
        J Am Soc Nephrol. 2001; 12: 368-373
        • Curtis J.J.
        Treatment of hypertension in renal allograft patients: does drug selection make a difference?.
        Kidney Int Suppl. 1997; 63: S75-S77
        • Curtis J.J.
        • Luke R.G.
        • Jones P.
        • et al.
        Hypertension in cyclosporine-treated renal transplant recipients is sodium dependent.
        Am J Med. 1988; 85: 134-138
        • Zeier M.
        • Mandelbaum A.
        • Ritz E.
        Hypertension in the transplanted patient.
        Nephron. 1998; 80: 257-268
        • Remuzzi G.
        • Perico N.
        Cyclosporine-induced renal dysfunction in experimental animals and humans.
        Kidney Int Suppl. 1995; 52: S70-S74
        • Coffman T.M.
        • Carr D.R.
        • Yarger W.E.
        • et al.
        Evidence that renal prostaglandin and thromboxane production is stimulated in chronic cyclosporine nephrotoxicity.
        Transplantation. 1987; 43: 282-285
        • Scherrer U.
        • Vissing S.F.
        • Morgan B.J.
        • et al.
        Cyclosporine-induced sympathetic activation and hypertension after heart transplantation.
        N Engl J Med. 1990; 323: 693-699
        • Goodwin J.E.
        • Zhang J.
        • Geller D.S.
        A critical role for vascular smooth muscle in acute glucocorticoid-induced hypertension.
        J Am Soc Nephrol. 2008; 19: 1291-1299
        • Woodle E.S.
        • First M.R.
        • Pirsch J.
        • et al.
        A prospective, randomized, double-blind, placebo-controlled multicenter trial comparing early (7 day) corticosteroid cessation versus long-term, low-dose corticosteroid therapy.
        Ann Surg. 2008; 248: 564-577
        • Opelz G.
        • Döhler B.
        • Laux G.
        Long-term prospective study of steroid withdrawal in kidney and heart transplant recipients.
        Am J Transplant. 2005; 5: 720-728
        • Evenepoel P.
        • Claes K.
        • Kuypers D.
        • et al.
        Impact of parathyroidectomy on renal graft function, blood pressure and serum lipids in kidney transplant recipients: a single centre study.
        Nephrol Dial Transplant. 2005; 20: 1714-1720
        • Kasiske B.L.
        • Chakkera H.A.
        • Roel J.
        Explained and unexplained ischemic heart disease risk after renal transplantation.
        J Am Soc Nephrol. 2000; 11: 1735-1743
        • Opelz G.
        • Dohler B.
        Improved long-term outcomes after renal transplantation associated with blood pressure control.
        Am J Transplant. 2005; 5: 2725-2731
        • Opelz G.
        • Wujciak T.
        • Ritz E.
        Association of chronic kidney graft failure with recipient blood pressure. Collaborative Transplant Study.
        Kidney Int. 1998; 53: 217-222
        • Mange K.C.
        • Cizman B.
        • Joffe M.
        • et al.
        Arterial hypertension and renal allograft survival.
        JAMA. 2000; 283: 633-638
        • Gago Fraile M.
        • Fernandez Fresnedo G.
        • Gomez-Alamillo C.
        • et al.
        Clinical and epidemiological characteristics of refractory hypertension in renal transplant patients.
        Transplant Proc. 2009; 41: 2132-2133
        • Gehr T.W.
        • Sica D.A.
        • Brater C.
        • et al.
        Furosemide pharmacokinetics and pharmacodynamics in renal transplantation.
        Clin Pharmacol Ther. 1988; 43: 547-553
        • Domenic A.
        • Sica M.D.
        • Todd W.B.
        • et al.
        Furosemide in renal transplantation.
        Int J Artif Organs. 1986; 9: 147-148
        • Lin H.Y.
        • Rocher L.L.
        • McQuillan M.A.
        • et al.
        Cyclosporine-induced hyperuricemia and gout.
        N Engl J Med. 1989; 321: 287-292
        • Arthur J.M.
        • Shamim S.
        Interaction of cyclosporine and FK506 with diuretics in transplant patients.
        Kidney Int. 2000; 58: 325-330
        • Curtis J.J.
        Management of hypertension after transplantation.
        Kidney Int Suppl. 1993; 43: S45-S49
        • Pollak R.
        • Maddux M.S.
        • Cohan J.
        • et al.
        Erythrocythemia following renal transplantation: influence of diuretic therapy.
        Clin Nephrol. 1988; 29: 119-123
        • Luke R.G.
        Pathophysiology and treatment of post-transplant hypertension.
        J Am Soc Nephrol. 1986; 2: S37-S44
        • Cross N.B.
        • Webster A.C.
        • Masson P.
        • et al.
        Antihypertensives for kidney transplant recipients: systematic review and meta-analysis of randomized controlled trials.
        Transplantation. 1986; 88: 7-18
        • Weir M.R.
        Calcium channel blockers in organ transplantation: important new therapeutic modalities.
        J Am Soc Nephrol. 1990; 1: S28-S38
        • Hilbrands L.B.
        • Hoitsma A.J.
        • van Hamersvelt H.W.
        • et al.
        Acute effects of nifedipine in renal transplant recipients treated with cyclosporine or azathioprine.
        Am J Kidney Dis. 1994; 24: 838-845
        • Remuzzi G.
        • Perico N.
        Protecting single-kidney allografts from long-term functional deterioration.
        J Am Soc Nephrol. 1998; 9: 1321-1332
        • Kloke H.J.
        • Wetzels J.F.
        • Koene R.A.
        • et al.
        Effects of low-dose nifedipine on urinary protein excretion rate in patients with renal disease.
        Nephrol Dial Transplant. 1998; 13: 646-650
        • Kasiske B.L.
        • Vazquez M.A.
        • Harmon W.E.
        • et al.
        Recommendations for the outpatient surveillance of renal transplant recipients.
        J Am Soc Nephrol. 2000; 11: S1-S86
        • Pesavento T.E.
        • Jones P.A.
        • Julian B.A.
        • et al.
        Amlodipine increases cyclosporine levels in hypertensive renal transplant patients: results of a prospective study.
        J Am Soc Nephrol. 2000; 7: 831-835
        • Weir M.R.
        Therapeutic benefits of calcium channel blockers in cyclosporine-treated organ transplant recipients: blood pressure control and immunosuppression.
        Am J Med. 1991; 90: 32S-36S
      2. K/DOQI clinical practice guidelines on hypertension and antihypertensive agents in chronic kidney disease.
        Am J Kidney Dis. 2004; 43: S1-S290
        • Stigant C.E.
        • Cohen J.
        • Vivera M.
        • et al.
        ACE inhibitors and angiotensin II antagonists in renal transplantation: an analysis of safety and efficacy.
        Am J Kidney Dis. 2000; 35: 58-63
        • del Castillo D.
        • Campistol J.M.
        • Guirado L.
        • et al.
        Efficacy and safety of losartan in the treatment of hypertension in renal transplant recipients.
        Kidney Int Suppl. 2000; 68: S135-S139
        • Vlahakos D.V.
        • Marathias K.P.
        • Agroyannis B.
        • et al.
        Post-transplant erythrocytosis.
        Kidney Int. 2003; 63: 1187-1194
        • Shihab F.S.
        • Bennett W.M.
        • Tanner A.M.
        • et al.
        Angiotensin II blockade decreases TGF-beta1 and matrix proteins in cyclosporine nephropathy.
        Kidney Int. 1997; 52: 660-673
        • Ahmad T.
        • Coulthard M.G.
        • Eastham E.J.
        Reversible renal failure due to the use of captopril in a renal allograft recipient treated with cyclosporin.
        Nephrol Dial Transplant. 1989; 4: 311-312
        • Garcia T.M.
        • da Costa J.A.
        • Costa R.S.
        • et al.
        Acute tubular necrosis in kidney transplant patients treated with enalapril.
        Ren Fail. 1994; 16: 419-423
        • Hiremath S.
        • Fergusson D.
        • Doucette S.
        • et al.
        Renin angiotensin system blockade in kidney transplantation: a systematic review of the evidence.
        Am J Transplant. 2007; 7: 2350-2360
        • Williams M.E.
        • Shaffer D.
        ACE inhibitor-induced transplant acute renal failure due to donor fibromuscular dysplasia.
        Nephrol Dial Transplant. 1999; 14: 760-764
        • Palmer B.F.
        Managing hyperkalemia caused by inhibitors of the renin-angiotensin-aldosterone system.
        N Engl J Med. 2004; 351: 585-592
        • Brenner B.M.
        • Cooper M.E.
        • de Zeeuw D.
        • et al.
        Effects of losartan on renal and cardiovascular outcomes in patients with type 2 diabetes and nephropathy.
        N Engl J Med. 2001; 345: 861-869
        • Lewis E.J.
        • Hunsicker L.G.
        • Clarke W.R.
        • et al.
        Renoprotective effect of the angiotensin-receptor antagonist irbesartan in patients with nephropathy due to type 2 diabetes.
        N Engl J Med. 2001; 345: 851-860
        • Knoll G.A.
        • Cantarovitch M.
        • Cole E.
        • et al.
        The Canadian ACE-inhibitor trial to improve renal outcomes and patient survival in kidney transplantation—study design.
        Nephrol Dial Transplant. 2008; 23: 354-358
        • Gress T.W.
        • Nieto F.J.
        • Shahar E.
        • et al.
        Hypertension and antihypertensive therapy as risk factors for type 2 diabetes mellitus. Atherosclerosis Risk in Communities Study.
        N Engl J Med. 2000; 342: 905-912
        • Donahoo W.T.
        • Kosmiski L.A.
        • Eckel R.H.
        Drugs causing dyslipoproteinemia.
        Endocrinol Metab Clin North Am. 1998; 27: 677-697
        • Kaijser M.
        • Johnsson C.
        • Zezina L.
        • et al.
        Elevation of cyclosporin A blood levels during carvedilol treatment in renal transplant patients.
        Clin Transplant. 1997; 11: 577-581
        • Fernandez-Fresnedo G.
        • Escallada R.
        • Martin de Francisco A.L.
        • et al.
        Association between pulse pressure and cardiovascular disease in renal transplant patients.
        Am J Transplant. 2005; 5: 394-398
        • Mange K.C.
        • Feldman H.I.
        • Joffe M.M.
        • et al.
        Blood pressure and the survival of renal allografts from living donors.
        J Am Soc Nephrol. 2004; 15: 187-193
        • Amer H.
        • Fidler M.E.
        • Myslak M.
        • et al.
        Proteinuria after kidney transplantation, relationship to allograft histology and survival.
        Am J Transplant. 2007; 7: 2748-2756
        • Amer H.
        • Cosio F.G.
        Significance and management of proteinuria in kidney transplant recipients.
        J Am Soc Nephrol. 2009; 20: 2490-2492
        • Halimi J.M.
        • Giraudeau B.
        • Buchler M.
        • et al.
        Enalapril/amlodipine combination in cyclosporine-treated renal transplant recipients: a prospective randomized trial.
        Clin Transplant. 2007; 21: 277-284