Surgical Correction of Posttransplant Renovascular Hypertension

The incidence of renovascular hypertension in the transplanted kidney is reported to range between 5 and 15%. A review of 391 consecutive renal transplant patients revealed 16 patients (5.4%) with hypertension secondary to partial obstruction of renal arterial blood flow. The clinical course of this group of patients was marked by early normotension followed by progressive diastolic pressure elevation, with improving renal function and loss of accumulated excess volume. Five etiologic factors are responsible for impaired arterial flow in this group of patients. Indication for operation was based on hypertension and/or impaired renal function. Patch angioplasty using saphenous veins was the procedure of choice in most instances. The average blood pressure was 185 mmHg; systolic/125 mmHg; diastolic preoperatively, compared with 140 mmHg; systolic/90 mmHg: diastolic postoperatively. Twelve of 16 patients had good results, and improvement in renal function was observed in eight patients. Serum renin levels did not correlate well with the operative findings. The use of meticulous technique, combined with maximum use of autogenous tissue, is emphasized.