Bilateral native nephrectomy for refractory hypertension in kidney transplant and kidney pancreas transplant patients.

Hypertension is common in renal transplant patients and sometimes very difficult to control. Refractory hypertension can adversely affect renal graft and patient survival. Many antihypertensive medications are not well tolerated or can have important drug interactions with immunosuppressive medications. These drugs can cause significant side effects including fluid depletion, azotemia, electrolyte imbalance, and anemia. Bilateral native nephrectomy in renal transplant patients has been reported to be beneficial in controlling severe hypertension. We report five patients with severe hypertension despite as many as 9 different antihypertensive medications. All patients had previous kidney or simultaneous kidney pancreas transplantation. Each of our patients underwent laparoscopic bilateral native nephrectomy. Renal function varied from creatinine of 1.4-2.4, and the number of antihypertensive medications from 3 to 9 at the time of nephrectomy surgery. Mean arterial blood pressure improved in all five patients at 3-6 months post nephrectomy, the number of antihypertensive medications decreased in 4, but renal function remained stable at 3-6 months in only 3 patients. We found laparoscopic bilateral native nephrectomy to be beneficial in renal and simultaneous kidney pancreas transplant patients with severe and refractory hypertension. Our patients with better baseline renal allograft function at time of nephrectomy received the most benefit. No decrease in allograft function could be attributed to acute rejection.