Renal sympathetic denervation in Sweden: a report from the Swedish registry for renal denervation.

BACKGROUND: Renal denervation (RDN) is a catheter-based intervention to treat patients with resistant hypertension. The biological effects of RDN are not fully understood, and randomized controlled trials have generated conflicting evidence. This report presents data from the Swedish Registry for Renal Denervation, an investigator-driven nationwide registry. PURPOSE: To assess the safety and efficacy of RDN on patients with resistant hypertension in a real-world clinical setting. METHODS: This nationwide database contains patient characteristics, procedural details, and follow-up data on all RDN procedures performed in Sweden. Consecutive procedures between 2011 and 2015 were included. RESULTS: The data analysis consists of 252 patients (mean age 61 ±â€Š10 years, 38% women; mean 4.5 ±â€Š1.5 antihypertensive drugs). Office SBP and DBP and 24-h ambulatory blood pressure (BP) decreased 6 months after RDN (176 ±â€Š23/97 ±â€Š17 to 161 ±â€Š26/91 ±â€Š16 mmHg, both P < 0.001; and 155 ±â€Š17/89 ±â€Š14 to 147 ±â€Š18/82 ±â€Š12 mmHg, both P < 0.001). Significant office and ambulatory BP reductions persisted throughout the observation period of 36 months. Major procedure-related vascular complications occurred in four patients. Renal function and number of antihypertensive drugs were unchanged during follow-up. CONCLUSION: In this complete national cohort, RDN was associated with a sustained reduction in office and ambulatory BP in patients with resistant hypertension. The procedure proved to be feasible and associated with a low-complication rate, including long-term adverse events.

Low molecular weight heparin prophylaxis increases the incidence of lymphocele after kidney transplantation.

Lymphocele formation after kidney transplantation has become more frequent at our department after the introduction of routine thromboembolic prophylaxis with low molecular weight heparin (LMWH). A consecutive series of 130 kidney transplant recipients were included in a retrospective study. Fifty-eight patients received prophylaxis and 72 did not. Other background data between the two patient groups was comparable. Lymphocele was diagnosed by ultrasound. Lymphocele formation was significantly more common (p<0.01) among patients who received LMWH prophylaxis (43%) than patients who did not (20%). There was no increase in bleeding-related complications in the prophylaxis group. An interesting finding was that, in the prophylaxis group, fewer grafts were lost due to vascular complications or early rejection, leading us to conclude that the use of LMWH increases the incidence of lymphocele formation after kidney transplantation, but may also reduce early graft loss due to thrombosis and vascular rejection.