Intractable renovascular hypertension in an adult recipient of a pediatric cadaveric renal transplant

Renovascular hypertension developed in an anephric 37 year old patient after he received a cadaveric renal transplant from a 2 year old donor. Despite adequate homograft function, a transplant nephrectomy was performed because of intractable, life threatening hypertension. There was relative stenosis throughout the course of the transplanted renal artery. Pathologic examination of the kidney did not demonstrate evidence of technical failure or immunological or hypertensive damage. Atrophic changes in the media of the renal artery may have resulted from radiation damage. The hypertension appears to have been caused by disproportionate growth between the parenchyma in the hypertrophying pediatric homograft and its renal artery.