Hypertension after lung transplantation

Hypertension is a recognized side effect of cyclosporine administration after kidney, heart, and bone-marrow transplantation. The incidence has not been previously reported after lung transplantation. We reviewed the incidence and potential causes of hypertension in recipients of single and double lung transplants. Twenty-one previously normotensive, stable recipients of lung transplants were reviewed retrospectively to determine the incidence of hypertension. Renal function as measured by blood urea nitrogen, creatinine, prednisone, and cyclosporine levels and dosages were determined at time of onset of hypertension. Hypertension developed in 14 of 21 previously normotensive patients (66%) followed from 4 to 64 months after transplantation (mean onset 11 months after transplantation). Renal function was diminished in all patients after transplantation. Neither the level of renal dysfunction nor cyclosporine dosage or level predicted the development of hypertension. The incidence of hypertension in lung transplant recipients was comparable to that reported in cyclosporine-treated kidney transplant patients (67%) and bone-marrow transplant patients (60%) but was less than that in heart transplant recipients (90%). Preserved cardiac innervation may explain the lower incidence of hypertension in lung compared with heart transplant recipients in the presence of comparable immunosuppressives and renal function. Time to onset of hypertension in lung transplant recipients is delayed compared with that in other organ transplants. This suggests that additional mechanisms as yet unexplored may be invoked.