Pretransplant Midodrine Use

Alhamad, Tarek; Brennan, Daniel C.; Brifkani, Zaid; Xiao, Huiling; Schnitzler, Mark A.; Dharnidharka, Vikas R.; Axelrod, David A.; Segev, Dorry L.; Lentine, Krista L.

doi:10.1097/tp.0000000000001113

Cited by 27 publications

(13 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Interestingly, the RI during protocol biopsies correlates more with recipients’ factors (for example, age and central hemodynamic factors) than with graft or histologic factors 10 . Hypotension in the pre-transplant period might also be a risk factor for adverse outcomes in the post-transplant period, evidenced by recent studies associating the use of midodrine in the pre-transplant period with graft failure, death, and major adverse cardiovascular events (MACE) post-transplant 11, 12 .…”

Section: Cardiovascular Diseasementioning

confidence: 99%

Non-immunological complications following kidney transplantation

2019

View full text Add to dashboard Cite

Kidney transplantation (KT) is the most effective way to decrease the high morbidity and mortality of patients with end-stage renal disease. However, KT does not completely reverse the damage done by years of decreased kidney function and dialysis. Furthermore, new offending agents (in particular, immunosuppression) added in the post-transplant period increase the risk of complications. Cardiovascular (CV) disease, the leading cause of death in KT recipients, warrants pre-transplant screening based on risk factors. Nevertheless, the screening methods currently used have many shortcomings and a perfect screening modality does not exist. Risk factor modification in the pre- and post-transplant periods is of paramount importance to decrease the rate of CV complications post-transplant, either by lifestyle modification (for example, diet, exercise, and smoking cessation) or by pharmacological means (for example, statins, anti-hyperglycemics, and so on). Post-transplantation diabetes mellitus (PTDM) is a major contributor to mortality in this patient population. Although tacrolimus is a major contributor to PTDM development, changes in immunosuppression are limited by the higher risk of rejection with other agents. Immunosuppression has also been implicated in higher risk of malignancy; therefore, proper cancer screening is needed. Cancer immunotherapy is drastically changing the way certain types of cancer are treated in the general population; however, its use post-transplant is limited by the risk of allograft rejection. As expected, higher risk of infections is also encountered in transplant recipients. When caring for KT recipients, special attention is needed in screening methods, preventive measures, and treatment of infection with BK virus and cytomegalovirus. Hepatitis C virus infection is common in transplant candidates and in the deceased donor pool; however, newly developed direct-acting antivirals have been proven safe and effective in the pre- and post-transplant periods. The most important and recent developments on complications following KT are reviewed in this article.

show abstract

Section: Cardiovascular Diseasementioning

confidence: 99%

Non-immunological complications following kidney transplantation

2019

View full text Add to dashboard Cite

show abstract

“…In KT alone patients, end-stage renal disease largely develops from hypertension and diabetes, which lead to calcification and remodeling of large vessels and arterial stiffening resulting in decreased vascular compliance, myocardial fibrosis resulting in diastolic dysfunction, and autonomic dysfunction. 5 These physiologic changes tend to worsen with hemodialysis use and with more time awaiting organ transplantation. A patient with this underlying pathophysiology, who then develops hypotension with or without hemodialysis, represents a higher risk patient, as their hypotension is likely related to concomitant cardiovascular compromise.…”

Section: Discussionmentioning

confidence: 99%

“…The need for midodrine before kidney transplantation (KT) alone has been shown to increase the risk for poor posttransplant outcomes including delayed graft function, graft failure, and death. 5 , 6 As a result, in the kidney transplant program at our institution, the need for midodrine is a contraindication to listing for kidney transplant. However, specifically in cases of liver transplantation alone for HRS, pretransplant use of midodrine has not been associated with differences in renal function or mortality.…”

Section: Introductionmentioning

confidence: 99%

Need for Pretransplant Midodrine Does Not Negatively Impact Simultaneous Liver-kidney Transplant Outcomes

Barman

King

Berg

et al. 2020

Transplantation Direct

View full text Add to dashboard Cite

Background. Midodrine is often needed pretransplant to improve hemodynamics in simultaneous liver-kidney transplant candidates. Previous research has shown that patients requiring midodrine before kidney transplant alone have increased posttransplant risk for delayed allograft function, graft failure, and death. However, the impact of pretransplant midodrine use on outcomes after simultaneous liver-kidney transplant is unknown. Methods. We performed a retrospective study of all adult (age ≥18 y) simultaneous liver-kidney transplant recipients from a single academic transplant center from February 1, 2002, to June 30, 2019. Results. Sixty-four simultaneous liver-kidney transplants were performed in our institution during this time period, of which, 43 were not on midodrine before transplant, 17 were on midodrine alone, and 4 were on intravenous (IV) vasopressor therapy. Despite the midodrine group having a higher MELD-Na at listing, higher MELD-Na at transplant, and being older, there were no significant differences in key outcomes including delayed renal allograft function, estimated glomerular filtration rate at transplant discharge, and estimated glomerular filtration rate at 1 y after transplant compared with the nonmidodrine group. There was no significant difference in graft failure or survival at last follow-up. Conclusions. Our study suggests that need for pretransplant midodrine should not be a barrier to simultaneous liver-kidney transplant.

show abstract

“…Prior studies have shown a higher risk of DGF among patients with pretransplant hypotension 5 and those taking midodrine, a commonly used medication for intradialytic hypotension. 6,7 Whether the association of DGF and blood pressure holds true across the range of blood pressure and whether this risk differs for certain high-risk donor and recipient phenotypes is unclear. Also, hypotension is likely a marker of high-risk recipient phenotype [8][9][10][11][12] and it is possible that blood pressure potentially mediates some of the DGF risk in high-risk recipients, but the extent of this contribution is not well studied.…”

Section: Introductionmentioning

confidence: 99%

“…Identifying risk factors that may be potentially modifiable would allow for interventions to lower DGF incidence. Prior studies have shown a higher risk of DGF among patients with pre‐transplant hypotension 5 and those taking midodrine, a commonly used medication for intradialytic hypotension 6,7 . Whether the association of DGF and blood pressure holds true across the range of blood pressure and whether this risk differs for certain high‐risk donor and recipient phenotypes is unclear.…”

Section: Introductionmentioning

confidence: 99%

Preoperative blood pressure and risk of delayed graft function in deceased donor kidney transplantation

Wazir

Abbas

Ratanasrimetha

et al. 2022

Clinical Transplantation

View full text Add to dashboard Cite

Background In kidney transplantation, delayed graft function (DGF) is associated with increased morbidity and a higher risk of graft failure. Prior research suggests that chronic hypotension increases DGF risk, but the relationship of preoperative blood pressure to DGF is unclear. Methods In this single center study of adult deceased donor kidney transplant recipients transplanted between 2015 and 2019, we evaluated the question of whether preoperative mean arterial pressure (MAP) affected DGF risk. Additionally, we investigated whether the risk of DGF was moderated by certain donor and recipient characteristics. For recipient characteristics associated with increased DGF risk and preoperative MAP, we performed a mediation analysis to estimate the proportion of DGF risk mediated through preoperative MAP. Results Among 562 deceased donor kidney recipients, DGF risk decreased as preoperative MAP increased, with a 2% lower risk per 1 mm Hg increase in MAP. This increased risk was similar, with no statistically significant interaction effect between preoperative MAP and donor (donation after circulatory death) and recipient characteristics (diabetes, body mass index, and use of anti‐hypertensive medications). Preoperative MAP was negativity correlated with recipient BMI and duration of pre transplant dialysis. On mediation analysis, MAP accounted for 12% and 16% of the DGF risk associated with recipient BMI and pre‐transplant dialysis duration, respectively. Conclusion In deceased donor kidney transplantation, each 1 mm Hg increase in preoperative MAP was associated with 2% lower DGF risk. Preoperative MAP was influenced by recipient BMI and dialysis duration, and likely contributes to some of the high DGF risk from obesity and long dialysis vintage.

show abstract

Pretransplant Midodrine Use

Cited by 27 publications

References 33 publications

Non-immunological complications following kidney transplantation

Non-immunological complications following kidney transplantation

Need for Pretransplant Midodrine Does Not Negatively Impact Simultaneous Liver-kidney Transplant Outcomes

Preoperative blood pressure and risk of delayed graft function in deceased donor kidney transplantation

Contact Info

Product

Resources

About