Recipient pre-existing chronic hypotension is associated with delayed graft function and inferior graft survival in kidney transplantation from elderly donors

Abstract

Background Pre-existing chronic hypotension affects a percentage of kidney transplanted patients (KTs). Although a relationship with delayed graft function (DGF) has been hypothesized, available data are still scarce and inconclusive. Methods A monocentric retrospective observational study was performed on 1127 consecutive KTs from brain death donors over 11 years (2003–2013), classified according to their pre-transplant Mean Blood Pressure (MBP) as hypotensive (MBP < 80 mmHg) or normal-hypertensive (MBP ≥ 80 mmHg, with or without effective antihypertensive therapy). Results Univariate analysis showed that a pre-existing hypotension is associated to DGF occurrence (p<0.01; OR for KTs with MBP < 80 mmHg, 4.5; 95% confidence interval [CI], 2.7 to 7.5). Chronic hypotension remained a major predictive factor for DGF development in the logistic regression model adjusted for all DGF determinants. Adjunctive evaluations on paired grafts performed in two different recipients (one hypotensive and the other one normal-hypertensive) confirmed this assumption. Although graft survival was only associated with DGF but not with chronic hypotension in the overall population, stratification according to donor age revealed that death-censored graft survival was significantly lower in hypotensive patients who received a KT from >50 years old donor. Conclusions Our findings suggest that pre-existing recipient hypotension, and the subsequent hypotension-related DGF, could be considered a significant detrimental factor, especially when elderly donors are involved in the transplant procedure.

Vasopressin for Post-kidney Transplant Hypotension

“…Further analysis of 18 paired grafts in different recipients (hypotensive vs. nonhypotensive) showed that the odds of DGF were 7 times higher compared with normotensive pairs. Pretransplant hypotension was also shown to be associated with perioperative hypotension and perioperative fluid administration of >3 L. 1 In our study, the vasopressin group received significantly less net fluid compared with no-vasopressin groups but ended up with a nonsignificant higher net positive fluid status in the first 24 hours post-DDKT owing to significantly less urine output (2.3 L vs. 4.6 L, P < 0.0001).…”

“…A study from Dolla et al. 1 looking at pretransplant hypotension showed that the odds of DGF were 4.5 times higher with mean BP <80 mm Hg. Further analysis of 18 paired grafts in different recipients (hypotensive vs. nonhypotensive) showed that the odds of DGF were 7 times higher compared with normotensive pairs.…”

“…Hypotension before, during, and after DDKT is associated with worse outcomes, increased rates of DGF, and poor GS. 1 , 2 Hypotension in people requiring dialysis can be multifactorial including owing to hypovolemia, autonomic neuropathy, vascular calcifications, arteriopathy, and from polypharmacy for management of hypertension. In the immediate perioperative period, this can result in several complications to the DDKTRs because of hypoperfusion and demand ischemia including cardiac hypoperfusion, arrhythmias, myocardial injury, stroke, and alteration of mental status.…”

Acute kidney injury after hip fracture in organ transplant recipients

“…In addition, the occurrence of intraoperative hypotension was slightly higher in the KT and LT groups compared with the nontransplantation group. As a higher risk of delayed graft function secondary to a hypotension‐mediated reduction in renal blood flow was reported previously, 50 the impact of intraoperative hypotension on kidney function might be higher in kidney transplant recipients. Therefore, team‐based approach, including an anesthesiologist, a nephrologist, and a surgeon, in order to avoid intraoperative hypotension during hip fracture surgery, will be important for better outcomes, particularly in KT transplant recipients.…”

Kidney Transplant Outcomes after Prolonged Delayed Graft Function

“…Most transplant recipients in the study were Caucasian and Black, limiting the generalizability of our findings. As with other retrospective studies, our analysis may be confounded by variables that were not included in our models, such as blood loss, kidney allograft size, perioperative hypotension [ 24 ], proteinuria or nephrotic syndrome, and immunosuppressant choice and level. Our follow-up was only one year.…”