Taegtmeyer AB et al. (2004) Reduced incidence of hypertension after heterotopic cardiac transplantation compared with orthotopic cardiac transplantation. J Am Coll Cardiol 44: 1254–1260

Hypertension frequently develops following organ transplantation, partly as a consequence of ciclosporin treatment. Since hypertension is more common in heart transplant patients than in liver or lung transplant recipients, it is possible that removal of the recipient's heart contributes to the problem. In orthotopic cardiac transplant (OCT), the native heart is replaced with the denervated donor heart. In heterotopic heart transplant (HHT), a less common procedure, the recipient heart and its innervation are left in situ. Taegtmeyer et al. hypothesized that the incidence of hypertension in HHT patients would, therefore, be lower than in OCT patients.

The authors examined retrospective data from 271 patients, of whom 233 had undergone OCT and 38 had undergone HHT. At 3 months post-transplantation, systolic blood pressure was significantly lower in the HHT group than in the OCT group, despite greater use of antihypertensive drugs in the OCT patients. This difference in systolic blood pressure persisted throughout the 5-year period studied. Multivariate analysis revealed that, compared with OCT, HHT was independently associated with lower systolic blood pressure.

The study supports the idea that the native heart has a role in blood pressure homeostasis following HHT, and suggests that its removal is involved in the development of hypertension after OCT.