TREATMENT OF POSTTRANSPLANT HYPERTENSION BY LAPAROSCOPIC BILATERAL-NEPHRECTOMY

Background. Hypertension is an important risk factor for the developme nt of chronic graft failure and decreased graft and patient survival a fter renal transplantation, Methods. Between September 1994 and August 1996, 14 patients underwent laparoscopic bilateral nephrectomy for tr eatment of drug-resistant hypertension after successful renal transpla ntation. Common causes of hypertension were largely excluded before bi lateral nephrectomy, A scoring system was developed for comparison of different antihypertensive regimes. In this system, points were given according tee type and dosage of each antihypertensive drug. Results. At 6-month follow-up, all patients showed well-controlled blood pressu re (median of mean arterial pressure: 104 vs, 130 mmHg preoperatively, P<0.001, n=14), and significantly fewer antihypertensive drugs were n eeded according to the scoring system (48.9+/-20.9 points vs. 105.9+/- 23.5 points preoperatively, P<0.001, n=14). During laparoscopy, three conversions to open surgery were necessary. Postoper atively, four com plications occurred. After laparoscopy, immunosuppression and other or al medication were given continuously. The hospital stay ranged betwee n 3 and 6 days (median: 5 days). Conclusions. The results indicate tha t bilateral nephrectomy using the laparoscopic technique can be an eff ective alternative method for a selected group of patients with severe hypertension, which is unresponsive to conservative management after successful renal transplantation with regard to improving the long-ter m graft survival.