Bilateral nephrectomy of the native kidneys reduces the incidence of arterial hypertension and erythrocytosis in kidney graft recipients treated with cyclosporin. Leuven Collaborative Group for Transplantation.

Since the use of cyclosporin (CsA) the incidence of post-transplant arterial hypertension and erythrocytosis has increased sharply. In a retrospective analysis of 707 consecutive first cadaveric kidney graft recipients treated with CsA as basic immunosuppression, the effect of bilateral native nephrectomy on arterial hypertension and erythrocytosis was studied. Patient and graft survival as well as kidney function of the 264 nephrectomized patients were identical to those of the 443 non-nephrectomized patients. In the nephrectomized patients the mean number of rejections during the first year was 0.62 +/- 0.88 versus 0.78 +/- 1.02 in the non-nephrectomized patients (P = 0.0285). At 1 year after transplantation, 65.8% of the non-nephrectomized patients needed hypotensive drugs versus 45.3% of the nephrectomized patients (P < 0.0001). Notwithstanding the use of more antihypertensive drugs, diastolic blood pressure in the former group was significantly higher than in the latter group (87 +/- 25 versus 83 +/- 10 mmHg; P < 0.02). During the first year 44 (9.9%) of the non-nephrectomized patients had haemoglobin levels higher than 17 g/dl versus only six (2.3%) of the nephrectomized patients (P < 0.0001). Comparable differences were also found up to 5 years after transplantation. These findings indicate that native nephrectomy is helpful in controlling arterial hypertension and erythrocytosis.