Severe hypertension prior to renal transplantation has traditionally been an indication for bilateral nephrectomy (BN). Nevertheless the impact of BN on the prevalence of hypertension after successful renal transplantation has not been will documented. Purpose: to clarify the effect of bilateral nephrectomy on blood pressure pattern and control in renal transplant patients. Materials & Methods: We retrospectively reviewed 24 patients who underwent native nephrectomy between November 97 and January 06, 22 of them were under treatment with antihypertensive medications according to the international guidelines. Out of the 24 cases 15 operated for resistant hypertension, named group 1 (G1), 9 patients with indications other than hypertension collected in group 2 (G2). Nephrectomy was done either simultaneous, before or after transplantation. All patients received triple immunosuppresion according to the local protocol, calcinurein (CNI), mycofinolate mofetil (MMF) or azathioprine, and prednisolone. Antihypertensive therapy was evaluated before and after BN. Acute rejections (ACR) as will as CNI nephrotoxicity episodes were recorded.
Results: In G1 mean age was 30.2 years (range 10 to 62), 5 patients had acute rejection episodes (33.3%) and 3 episodes of CNI nephrotoxicity (20%); in G2 mean age was 33.67 years (range 11 to 61), 2 patients had ACR episodes (22%), and two had CNI nephrotoxicity (22%). Patients in G1 used (3.6+1.05) (mean+SD) antihypertensive drug/day before BN, which is significantly higher than in the G2, (2.0+1.65) drugs/day (p=0.02). Three months after nephrectomy it came down to (2.69+0.94) drugs/day in G1, and remained (2.0+1.29) drugs/day in G2. After BN in G1 the difference is sustained at one year with further reduction of the antihypertensives at three years (1.46+1.33) drugs/day. Statistical significance difference between figures before and after BN in G1 was found only at three years (p=0.008). No Statistical significance between G1 and G2 after BN. In G2 Number of drugs shows an insignificant difference of (2.2+1.49) at one year, and (1.62+1.30) drugs/day at three years. Conclusion: We concluded that BN in renal transplant patients could result in better control of resistant hypertension, and its complications are within acceptable ranges.