Hypertension after renal homotransplantation occurs in from 30% to 50% of cases. Hypertension during the posttransplant period can be caused by many factors: the presence of the patient's own kidneys, acute or chronic graft rejection, renal artery stenosis in the homograft, acute ureteral obstruction, recurrence of the original renal disease, persistence of essential hypertension, a genetic predisposition for hypertension, and the effect of corticosteroids. From this list, it can be appreciated that pinpointing the cause and understanding the mechanisms for hypertension of transplant recipients can be difficult, especially because many of the potential causes with differing mechanisms may coexist in the same patient.
In this issue of the Archives, Rao and collaborators have reported their experience with hypertension in a large transplant population (p 1236). They limited their study to patients who had had a functioning renal homograft for at least six months. Several of their observations provoke comment.