Unique Considerations When Managing Hypertension in the Transplant Patient

Abstract

For the select fortunate recipients of organ transplants, transplantation affords the rare opportunity for a new life. Given the scarcity of organs for transplantation, it is imperative that the health of transplant recipients be optimized in order to fully benefit from this gift of life. Unfortunately, hypertension is highly prevalent in the transplant population and it is considered a major cardiovascular risk factor contributing to mortality and morbidity in this population. In this chapter, we expound on the epidemiology, unique pathophysiology, evaluation, and management of hypertension as it pertains to the solid organ transplant recipient. In addition, a brief commentary is made on the subject of hypertension following living kidney donation, and practical aspects of management of hypertension in the solid organ recipient are summarized at the end of the chapter.

Case report: Endovascular treatment of transplant renal artery stenosis in patient with normal color duplex ultrasound of the renal artery

“…Furthermore, suture technique and vascular clamp injury to the vessel lead to intimal hyperplasia and stenosis. 2 Vascular complications present with worsening renal function, edema, severe hypertension (an increasing requirement for antihypertensive drugs) with or without graft dysfunction, elevated serum creatinine levels, bruits, and lower limb claudication. In patients with clinical manifestations of stenosis, biochemical workup and imaging studies of iliac and graft vessels such as duplex ultrasound, CTA, or magnetic resonance angiography (MRA) should be performed.…”

“…Therefore, stenotic lesions commonly occur in transplant patients with underlying peripheral arterial disease and atherosclerotic damage to the vessels. Furthermore, suture technique and vascular clamp injury to the vessel lead to intimal hyperplasia and stenosis 2 …”

“…In cases where renal artery stenting is not effective or when very severe stenoses prevent access, surgery may be necessary. The surgical intervention's optional approaches include patch grafting, stenotic segment saphenous vein bypass graft, localized endarterectomy, and anastomosis resection and revision 2 . Stent migration and embolisation, side branch obstruction, late thrombosis, rupture, and aneurysm formation are uncommon complications associated with stent implementation 8,11 .…”

“…One known consequence among recipients of renal transplants is graft renal artery stenosis. Clinical manifestations include graft malfunction, rising creatinine levels, and recent onset or refractory hypertension are most frequently observed 2 . Therefore, it is crucial to establish early diagnosis and therapy to prevent graft malfunction and the serious consequences that may follow in various organs as a result of severe hypertension 3 …”

“…Clinical manifestations include graft malfunction, rising creatinine levels, and recent onset or refractory hypertension are most frequently observed. 2 Therefore, it is crucial to establish early diagnosis and therapy to prevent graft malfunction and the serious consequences that may follow in various organs as a result of severe hypertension. 3 To identify vascular issues as soon as feasible, subsequent examinations after kidney transplantation should be carried out, including studies to detect graft perfusion impairment.…”