Hypertension after pancreas-kidney transplantation: Role of bladder versusenteric pancreatic drainage.

Background Recent reports suggest that hypertension may be less common afte r simultaneous pancreas-kidney transplantation than after kidney transplant ation alone. However, the mechanisms for this beneficial effect have not be en delineated. We hypothesize that lower blood pressures may result from ch ronic volume depletion in patients with bladder-drained pancreatic allograf ts, Methods. We compared the incidence and severity of hypertension 12 months a fter transplantation in 79 bladder-drained pancreas-kidney recipients and 4 6 diabetic kidney-only recipients. These two groups were compared with a sm aller group of enterically drained pancreas-kidney recipients. Blood pressu re was also compared before and after surgical conversion from bladder to e nteric drainage in 10 patients. Results. Hypertension was significantly less common and less severe after p ancreas-kidney transplantation than after kidney transplantation alone, but the benefit of the pancreas transplant was evident only in bladder-drained patients, Logistic regression analysis of the bladder-drained pancreas-kid ney patients confirmed the independent impact of the pancreatic allograft o n the presence of hypertension, indicated an independent association with s erum creatinine concentration and donor age, but suggested no correlation w ith recipient age, race, or number of rejection episodes. A comparison of b lood pressures before and after pancreatic conversion from bladder to enter ic drainage indicated no significant change in the prevalence or severity o f hypertension, Conclusions. We conclude that the beneficial effect of a pancreas transplan t on the prevalence and severity of hypertension after simultaneous pancrea s-kidney transplantation is limited to bladder-drained patients. Although i t is possible that the effect is mediated by chronic volume depletion, the observation that blood pressure does not increase after conversion from bla dder to enteric drainage suggests that other factors may be involved.