Safety and Efficacy of Ultrasound Renal Denervation in Kidney Transplantation Patients With Uncontrolled Hypertension (RESTART)

Inclusion Criteria: Age ≥ 18 years Kidney transplantation ≥ 12 months ago with stable immunosuppressive drug treatment Estimated Glomerular Filtration Rate (eGFR) ≥ 40 ml/min/1.73m2 Office systolic BP ≥ 140 mmHg and a mean 24-hour ambulatory systolic BP ≥ 130 mmHg at screening Antihypertensive medication regimen: Stable regimen of at least two antihypertensive drugs of different classes, including a diuretic (defined a thiazide diuretic, loop diuretic or mineralocorticoid receptor antagonist), for at least three months, or Documented intolerance to three classes of antihypertensive drugs, and A change in antihypertensive drug regimen is not anticipated within the oncoming three months. Patient is willing and able to provide written informed consent Exclusion Criteria: Native renal artery anatomy not eligible for RDN, defined as at least one of the following conditions: History of renal artery stenting or angioplasty History of renal denervation History of kidney tumors Renal artery diameter < 3 mm or > 8 mm Renal artery length < 20 mm Fibromuscular disease (FMD) of the native renal arteries Renal artery aneurysm Renal artery stenosis > 30% Presence of a remnant transplant kidney after re-transplantation or absence of native kidneys Solitary native kidney History of intravenous contrast dye allergy or nephropathy Iliac/femoral artery stenosis precluding insertion of the Paradise catheter Uncorrected, treatable secondary cause of hypertension Pregnancy Life expectancy < one year at the discretion of the investigator