Changes in renin and blood pressure levels during renal transplantation

Early in the transplant program we experienced difficulty in maintaining the blood pressure after bilateral nephrectomy of a proportion of recipients receiving kidneys from living donors. To our surprise this problem was much less marked in the less prepared recipients with cadaver donors. It seemed possible that this could be related to our practice of preceeding transplantation with bilateral nephrectomy in the same session when the donor was alive, but not after necrotransplantation. A typical blood pressure chart from an operation combining renal transplantation with bilateral nephrectomy is shown in fig. 1. Even where there is no blood loss the systolic and diastolic blood pressure falls with the central venous pressure so that perfusion of the donor kidney is at first poor. As soon as perfusion is established however, the blood pressure rises.