1074 POST TRANSPLANT HYPERTENSION IN THE ABSENCE OF REJECTION OR RECURRENT DISEASE

Abstract

Post-transplant (Tx) hypertension (H) is extremely common among pediatric renal transplant recipients, occurring in 83% of our first 86 patients. In order to study H free of known concomitant causes, we studied those 16 of the 86 consecutive Tx in whom there had never been any rejection episode nor any recurrent disease. Follow-up period was 1-5 years. Patients (P) ranged in age from 3 to 24 years (median 16). All 16 P were hypertensive in the first post-operative week.

Nine P, all with various nephritides, had H pre-Tx, leading to pre-Tx nephrectomies (Nx) in 5. Post-Tx, all 9 were hypertensive during the first 6 months (2 - mild H, 7 - moderate H). By one year post-Tx, blood pressure had normalized in 2 P and was controlled on medication in 5 others. In contrast, of the 7 other patients, all with structural lesions (obstructive uropathy or hypoplasia-dysplasia), none had pre-Tx H, though 3 had pre-Tx Nx. Only 2 of these P had post-Tx H, mild in both. Steroid dosages were comparable in both nephritic and structural groups.

Our experience demonstrates that prior H correlates positively with post-Tx H, irrespective of native kidney nephrectomies. Patients with previous nephritides carry greatest risk of becoming hypertensive. Furthermore, the majority of young renal allograft recipients appear to develop hypertension, even in the absence of rejection or recurrent disease.

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