Beneficial effect of kidney transplantation from a deceased donor on severe chronic refractory intradialytic hypotension – a case report

Abstract

BackgroundChronic refractory hypotension (IDH, intradialytic hypotension) is a rare but serious problem encountered in patients on hemodialysis. Patients with chronic hypotension are often disqualified by transplant teams from renal transplantation. This is due to the possibility of an enormous risk of ischemic complications.Case presentationWe describe a 44-year old female patient with severe refractory hypotension (mean BP 60/30 mmHg, the lowest 48/28 mmHg), which appeared after bilateral laparoscopic nephrectomy of the infected kidneys. The kidney transplantation from a deceased donor, with infusion of the two pressor amines (dopamine, dobutamine) was performed without technical complications and the blood pressure measurements were 100–120/70–80 mmHg. The immunosuppression regimen was tacrolimus (TAC) + mycophenolate mophetil (MMF) and steroids (GS). Pressor amines were discontinued on the 18th day after the transplantation. Because of delayed graft function, 4 hemodialysis treatments were performed. The patient was discharged from the hospital on the 22nd day with good function of the transplanted kidney (the concentration of serum creatinine 117 μmol/l). During one-year follow-up, the patient has been remaining stable with a very good graft function (serum creatinine 84 μmol/l) and normal blood pressure (115/70 mmHg).ConclusionsProper preparation and adequate perioperative treatment allowed for safely performing kidney transplantation in the patient with severe IDH.

Refractory hypotension in an anephric patient: Immediate response to renal transplantation

“…Ignacak, et al presents the case of a 44-year old female post-bilateral nephrectomy for infected kidneys, with end-stage renal failure due to a rapidly progressing glomerulonephritis [11]. The patient underwent renal transplantation after three years of dialysis complicated by intradialytic hypotension.…”

Kidney transplantation from small pediatric donors may be feasible to those who developed chronic refractory dialysis hypotension: a single-center experience

“…In this retrospective study, we described ten single-kidney transplantations (group A, 5 kidneys were transplanted to CRDH adults, cases 1-5; group B, 5 to regular end-stage renal failure, controls 1-5) from five small pediatric donors of cardiac death donation in our Kidney Disease Center between August 2016 and April 2018. The median age of 5 donors was 28 months old and median body weight was 13 [12][13][14][15][16][17][18][19][20] kg. Their median level of serum creatinine (SCr) was 44 μmol/L at transplantation and blood type was consistent with that of recipients.…”

“…According to the National Kidney Foundation, IDH is defined as a decrease in systolic blood pressure (SBP) by ≥20 mmHg or a decrease in mean arterial pressure by ≥10 mmHg with clinical symptoms (14). Notably, there is one special form of IDH in 5-10% of dialysis patients, CRDH, defined as sustained SBP <100 mmHg during both intradialytic and interdialytic period generally (15,16). CRDH is a severe type of dialysisrelated hypotension and a sign of poor prognosis in dialytic patients.…”

“…CRDH is a severe type of dialysisrelated hypotension and a sign of poor prognosis in dialytic patients. It may lead to disqualification from kidney transplantation (15)(16)(17)(18)(19). These CRDH patients have less chance of transplantation and there has been only a few successful transplant cases from adult donors (15,16,(20)(21)(22).…”

“…It may lead to disqualification from kidney transplantation (15)(16)(17)(18)(19). These CRDH patients have less chance of transplantation and there has been only a few successful transplant cases from adult donors (15,16,(20)(21)(22). For these transplant recipients with CRDH, the BP remains hard to be maintained at a stable level and the recovery of graft function is difficult after transplantation (15,16,20,21).…”