Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Commentary
  • Published:

Hypertension after renal transplantation

Journal of Human Hypertension volume 18, pages 835–836 (2004)Cite this article

The relationships between blood pressure and kidney transplant recipients are complex. As more patients now reach end-stage kidney disease with large burdens of cardiovascular disease, more attention is being focused upon managing cardiovascular risk than ever before. Death with a functioning allograft, usually related to cardiovascular disease, is now one of the leading causes of graft loss.1 As a result, management of post-transplant hypertension has become an important component of the long-term medical care of the transplant recipient.

How blood pressure relates to the function and durability of the transplanted kidney also is an important issue. Post-transplant hypertension appears to be a risk for both rejection2 and eventual graft loss.3 Immunosuppression based upon calcineurin inhibitors, such as cyclosporine (Sandimmune, Neoral, Gengraf, etc) or tacrolimus (Prograf), itself produces widespread vasoconstriction and hypertension, particularly when combined with steroids.4 These agents induce complex changes in endothelial function, circadian rhythms and sodium retention, sometimes precipitating microangiopathic haemolytic injury.5 Long-term exposure to calcineurin inhibitors induces permanent vascular injury and interstitial fibrosis. Recent studies with serial biopsies in patients treated with calcineurin inhibitors indicate that this is nearly universal.6

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

References

  1. Pascual M et al. Strategies to improve long-term outcomes after renal transplantation. N Engl J Med. 2002; 346: 580–590.

    Article  Google Scholar 

  2. Cosio FG et al. Renal allograft survival following acute rejection correlates with blood pressure levels and histopathology. Kidney Int 2000; 56: 1912–1919.

    Article  Google Scholar 

  3. Mange KC, Cizman B, Joffe M, Feldman HI . Arterial hypertension and renal allograft survival. JAMA 2000; 283: 633–638.

    Article  CAS  Google Scholar 

  4. Textor SC et al. Posttransplantation hypertension related to calcineurin inhibitors. Liver Transplant 2000; 6: 521–530.

    Article  CAS  Google Scholar 

  5. Textor SC et al. Urinary endothelin and renal vasoconstriction with cyclosporine or FK506 after liver transplantation. Kidney Int 1995; 47: 1426–1433.

    Article  CAS  Google Scholar 

  6. Nankivell BJ et al. The natural history of chronic allograft nephropathy. N Engl J Med 2003; 349: 2326–2333.

    Article  CAS  Google Scholar 

  7. Neumayer HH, Kunzendorf U, Schreiber M . Protective effects of calcium antagonists in human renal transplantation. Kidney Int 1992; 41(Suppl 36): 87s–93s.

    Google Scholar 

  8. Palmer BF et al. Improved outcome of cadaveric renal transplantation due to calcium channel blockers. Transplantation 1991; 52: 640–645.

    Article  CAS  Google Scholar 

  9. Mehrens T et al. The beneficial effects of calcium channel blockers on long-term kidney transplant survival are independent of blood pressure reduction. Clin Transplant 2000; 14: 257–261.

    Article  CAS  Google Scholar 

  10. Premasathian NC et al. Blood pressure control in kidney transplantation: therapeutic implications. J Hum Hypertens 2004; 99: 9999.

    Google Scholar 

  11. Mange KC et al. Blood pressure and the survival of renal allografts from living donors. J Am Soc Nephrol 2004; 15: 187–193.

    Article  Google Scholar 

  12. Textor SC et al. Systemic and renal effects of nifedipine in cyclosporine-associated hypertension. Hypertension 1994; 23(Suppl I): I-220–I-224.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Nephrology and Hypertension, Mayo Clinic, 200 First Street Southwest, Rochester, 55905, MN, USA

    S C Textor

Authors
  1. S C Textor
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to S C Textor.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Textor, S. Hypertension after renal transplantation. J Hum Hypertens 18, 835–836 (2004). https://doi.org/10.1038/sj.jhh.1001766

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.jhh.1001766

Search

Advanced search

Quick links