title: Renal Artery Denervation in Patient After Heart and Kidney Transplantation With Refractory Hypertension.
abstract: We describe the case of a 54-year-old patient after renal and heart transplantation in whom uncontrolled hypertension was diagnosed. Despite combined antihypertensive therapy, no significant therapeutic effect was achieved. Clinical assessment of ambulatory blood pressure monitoring (ABPM) revealed the ineffectiveness of a bisoprolol, nitrendypin, klonidyn, ramipryl, furosemide, and doxasosine combination used at high doses. High blood pressure levels with their effect on a hypertrophic transplanted heart (left ventricular mass 254 g) and poor renal graft function (39 mL/kg/min) posed an extremely high risk of future cardiovascular complications, and were the reason to perform a native renal arteries denervation. The procedure was carried out through the right femoral artery with the use of a 6F guiding catheter. During a 1-year observation, significant decreases in ABPM systolic and diastolic blood pressures were observed after the procedure (168/88 mm Hg vs 154/77 mm Hg, respectively). Moreover a significant regression of left ventricular mass (215 g/m(2)) and stable renal graft function were noted. The presented case shows that native renal arteries denervation may be successful and safe in kidney and heart transplant recipients. Moreover, during the 1-year follow-up, the reduction in blood pressure was followed by a reduction in transplanted heart hypertrophy, both leading to regression of cardiovascular risk for the patient.
authors: Department of Cardiology, Wroclaw Medical University, Wroclaw, Poland.
authors: M
authors: M
authors: Protasiewicz
authors: Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wroclaw, Poland. Electronic address: m.banasik@interia.pl.
authors: M
authors: M
authors: Banasik
authors: Department of Radiology, Wroclaw Medical University, Wroclaw, Poland.
authors: J
authors: J
authors: Kurcz
authors: Department of Internal Disease and Hypertension, Wroclaw Medical University, Wroclaw, Poland.
authors: M
authors: M
authors: Podgórski
authors: Department of Cardiac Surgery and Transplantology, SMDZ in Zabrze, Medical University of Silesia in Katowice, Silesian Centre for Heart Disease, Zabrze, Poland.
authors: M
authors: M
authors: Zembala
authors: Department of Cardiac Surgery and Transplantology, SMDZ in Zabrze, Medical University of Silesia in Katowice, Silesian Centre for Heart Disease, Zabrze, Poland.
authors: M
authors: M
authors: Zakliczyński
authors: Department of Cardiology, Wroclaw Medical University, Wroclaw, Poland.
authors: A
authors: A
authors: Mysiak
authors: Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wroclaw, Poland.
authors: M
authors: M
authors: Boratyńska
authors: Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wroclaw, Poland.
authors: M
authors: M
authors: Klinger
mesh_terms: D003714:Denervation; D005260:Female; D016027:Heart Transplantation; D006801:Humans; D006973:Hypertension / Q000503:physiopathology / Q000601:surgery*; D007668:Kidney / Q000098:blood supply* / Q000503:physiopathology; D016030:Kidney Transplantation / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D012077:Renal Artery / Q000503:physiopathology / Q000601:surgery*