| Abstract|| |
Cardiovascular morbidity and mortality are extremely high in all stages of renal failure. Arterial hypertension remains a major problem even after renal transplantation. We studied retrospectively the hypertension patterns in recipients of renal allografts from living donors from January 1998 to December 2004. The mean age of the patients was 29.3 ± 9.4 (range 13 - 54) years, with a male predominance (62%). Among 42 of the study patients, 40 (95%) were hypertensive at 3 months after transplantation with a slightly decreasing prevalence at 6 and 12 months to 84% and 85%, respectively. During dialysis period, 59.5% of the patients were hypertensive. The allografts were left kidneys with only one artery in 40 patients and right kidneys with 2 arteries in 2 patients. Graft renal artery stenosis (RAS) was documented by Doppler ultrasound in 13 (32.5%) cases. Three patients improved following transluminal angioplasty with stenting. The control of the hypertension required the use of at least two antihypertensive drugs in 56% of patients. On an average follow-up of 30 (1 - 78) months, no cardiovascular event was reported and all the allografts remained functional. We conclude that hypertension is prevalent in the living renal allografts recipients. The etiology is multifactorial and careful management is mandatory to protect the renal function and the cardiovascular system.
Keywords: Renal, Transplantation, Hypertension, Living, Donors, Angioplasty
|How to cite this article:|
Sqalli TH, Laboudi A, Faik M, Benamar L, Amar Y, Ouzeddoun N, Bayahia R, Rhou H. Hypertension in Related Living Donor Renal Allograft Recipients. Saudi J Kidney Dis Transpl 2008;19:256-9
|How to cite this URL:|
Sqalli TH, Laboudi A, Faik M, Benamar L, Amar Y, Ouzeddoun N, Bayahia R, Rhou H. Hypertension in Related Living Donor Renal Allograft Recipients. Saudi J Kidney Dis Transpl [serial online] 2008 [cited 2020 Feb 25];19:256-9. Available from: http://www.sjkdt.org/text.asp?2008/19/2/256/39042
| Introduction|| |
Patients with renal insufficiency requiring renal dialysis or kidney transplantation are exposed to a high cardiovascular morbidity and mortality rates. Hypertension, with a prevalence range from 34 to 78%, remains a major medical and therapeutic problem after renal transplantation. Its most frequent causes include frequent use of corticosteroids and calcineurin-inhibitors, allograft renal artery stenosis, allograft dysfunction, and native kidneys abnormalities.
We aimed in this study to evaluate the hypertension patterns in our renal allograft recipients from living donors.
| Patients and Methods|| |
This study evaluated retrospectively hypertension patterns in recipient of allografts from living-related donors at Rabat University Hospital, Morocco from January 1998 to December 2004.
We observed the following variables: demographic data (age, gender and familial link), duration of hemodialysis, reason for transplantation, immunosuppressive therapy, and data of Doppler ultrasound post transplantation (at 2, 15 days, 1 and 3 months, then at every year interval). We also evaluated the anti-hypertensive treatment, evolution of the renal function, and presence of proteinuria.
Hypertension was defined as a systolic blood pressure above 140 mmHg and/or diastolic blood pressure above 90 mmHg, and/or by the use of anti-hypertensive drugs.
| Results|| |
Among 42 patients with renal allografts, 40 (95%) were hypertensive at 3 months after transplantation with a slightly decreasing prevalence at 6 and 12 months to 84% and 85%, respectively. The mean age was 29.3 ± 9.4 (range 13 - 54) years, with male predominance (62%). The etiology of the original kidney disease was unspecified 52.4% of the cases, whereas glomerulonephritis accounted for 26%, uropathies for 12% and interstitial nephritis for 2.4%. The mean duration of dialysis was 27 ± 18.9 (1 - 72) months. During this period, 59.5% of the patients were hypertensive. The mean age of the donors was 41 ± 10 (20 - 57) years, with a female prevalence (76%). The grafted kidney was a left kidney with only one artery in 40 cases and a right kidney with two arteries in two cases. Patients did not receive any induction therapy and were maintained on cyclosporine, prednisone and either mycophenolate mofetil (57%) or azathioprine (43%).
Graft renal artery stenosis (RAS) was documented by Doppler ultrasound in 13 (32.5%) patients. The mean interval to diagnosis was 52.8 ± 56 (2 - 180) days. Three patients improved following transluminal angioplasty with stenting, [Table - 1].
The medical management of hypertension required only one drug in 43% of the patients, 2 drugs in 31%, 3 drugs in 19%, and 4 drugs in 4.8 %. The various therapeutic classes were used with a prevalence of calcium inhibitors and angiotensin converting enzyme inhibitors. On an average follow-up of 30 (1 - 78) months, no cardiovascular event was reported and all the allografts remained functional with an average creatinine level of 121 ± 15 (77 - 198) µmol/L.
| Discussion|| |
The results of our study revealed high prevalence of hypertension in renal allograft recipients. It is comparable to the results of a Spanish study of 680 patients under cyclosporine (78% at 1 year) and higher than the prevalence published by Opelz et al in 1998 in a cohort of 29,751 patients (55.5% at one year). , The prevalence of hypertension decreased from 95% at one month after transplantation to 84.6% at 6 months and 85.7% at 1 year. This decrease can be explained by the reduction of the high initial corticosteroid and cyclosporine doses. Veenstra et al estimated that 15 % of incidence of hypertension was related to corticosteroid use.  The calcineurin-inhibitors were, on the other hand, an important factor supporting the development and the maintenance of the hypertension after transplantation via numerous mechanisms. The role of vasoconstriction of small renal arteries is well established. The prevalence of hypertension with tacrolimus is lower than that found with cyclosporine,  but this difference was not found after a 5- year follow-up. 
Three of our patients improved following angioplasty with stenting. In medical literature, the prevalence of allograft RAS varied from 1 to 23% with good results after allograft angioplasty or surgical repair. ,
In our study, the control of the hypertension required the use of at least two anti-hypertensive drugs in 56% of the cases. Calcium inhibitors showed their effectiveness not only in term of hypertension treatment but also to preserve renal function.  In addition, angiotensin converting enzyme inhibitors offer many advantages in term of renal and cardiac protection with a good tolerance in the majority of the cases with stability of creatinine during their use. 
We conclude that hypertension is prevalent in the living renal allografts recipients. The etiology is multifactorial and careful management is mandatory to protect the renal function and the cardiovascular system.
| References|| |
|1.||Campistol JM, Romero R, Paul J, GutierrezDalmau A. Epidemiology of arterial hypertension in renal transplant patients: Changes over the last decade. Nephrol Dial Transplant 2004;19[Suppl 3]:117-20. |
|2.||Opelz G, Wujziak T, Ritz E; For the Collaborative Transplant Study. Association of chronic kidney graft failure with recipient blood pressure. Kidney Int 1998;53:217-22. |
|3.||Midtvedt K, Hartmann A. Hypertension after kidney transplantation: are treatment guidelines emerging? Nephrol Dial Transplant 2001;16[suppl1]:117-20. |
|4.||Ligtenberg G, Hene RJ, Blankestijn PJ, Koomans HA. Cardio-vascular risk factors in renal transplant patients: Cyclosporin A versus tacrolimus. J Am Soc Nephrol 2001; 12(2):368-73. |
|5.||Murhead N, House A, Hollomby DJ, Jevnikar AM. A comparison between cyclosporine and tacrolimus based immunosuppression for renal allograft renal function and blood pressure after 5 years. Transplant Proc 2003;35(7):2391-4. |
|6.||Bruno S, Remuzzi G, Ruggenenti P. Transplant renal artery stenosis. J Am Soc Nephrol 2004;15(1):134-41. |
|7.||Patel NH, Jindal RM, Wilkin T, Rose S, Johnson MS, Shah H, et al. Renal arterial stenosis in renal allografts: Retrospective study of predisposing factors and outcome after percutaneous transluminal angioplasty. Radiology 2001;219(3):663-7. |
|8.||Morales JM, Rodriguez-Paternina E, Araque A, Andres A, Hernandez E, Ruilope LM, et al. Long-term protective effect of a calcium antagonist on renal function in hypertensive renal transplant patients on cyclosporine therapy: A 5-year prospective randomized study. Transplant Proc 1994; 26(5):2598-9. |
|9.||Stigant CE, Cohen J, Vivera M, Zaltzman JS. ACE inhibitors and angiotensin II antagonists in renal transplantation. An analysis of safety and efficacy. Am J Kidney Dis 2000;35(1):58-63. |
Tarik Houssaini Sqalli
Service d'hémodialyse, Batiment 5, Hôpital Al Ghassani, Fès, Maroc
[Table - 1]