Pulmonary hypertension and post-operative outcome in renal transplant: A retrospective analysis of 170 patients

Abstract

Background and Aims:Renal transplant is the best possible treatment for patients suffering with end-stage renal disease (ESRD). Cardiovascular events are the commonest factors contributing to perioperative morbidity and mortality in this population. These patients have a high incidence (up to 60%) of pulmonary hypertension (PH) and that may affect the perioperative outcome.Methods:In this study, we aimed to study the impact of PH on perioperative outcome after renal transplant. PH was defined as patients with pulmonary artery systolic pressure ≥35 mmHg on pre-operative echocardiography. Medical records of 170 patients who had undergone renal transplantation in the past 3 years were reviewed. Primary outcome was delayed graft functioning and secondary outcomes were perioperative complications such as hypotension, arrhythmias, need of post-operative mechanical ventilation, atelectasis and pulmonary oedema.Results:We observed 46.5% incidence of PH in ESRD patients. Compared to patients without PH, more patients with PH had postoperative hypotension (26.58% vs. 9.89%, P = 0.004) and delayed graft functioning (8.8% vs. 1.1%, P = 0.026). On multivariate analysis, however, PH was not an independent predictor of delayed graft functioning.Conclusion:In ESRD patients, although PH is not an independent predictor of delayed graft functioning, patients having PH are more prone for perioperative hypotension and delayed graft functioning after renal transplant.

Intensive ultrafiltration strategy restores kidney transplant candidacy for patients with echocardiographic evidence of pulmonary hypertension

“… 3 , 4 , 14 , 16 A commonly cited reason for this association is that patients with PH are more prone to perioperative hypotension which can lead to DGF and potentially failure. 35 However, we observed that the incidence of DGF (6/11 transplanted patients; 54.5%) in post‐transplant patients did not correlate with perioperative hypotension (3/11 transplanted patients; 27.2%); and that even patients who were at a goal mean arterial pressure (MAP) intra‐operatively were at risk for DGF. Therefore, need for dialysis in the immediate post‐operative setting did not portend a poor prognosis for graft function at 1‐year.…”

Pregnancy outcomes in renal transplant recipients

“…Patients on tacrolimus have to avoid breastfeeding up to 4 hours after taking a dose. [ 10 ] Patients on cyclosporine are advised against breastfeeding.…”

Development and Validation of a Nomogram for Predicting All-Cause Mortality in Patients with Hemodialysis Having Pulmonary Hypertension

“…Most HD patients with PH have impaired left ventricular systolic function, which increases the risk of developing heart failure [11]. In renal transplant recipients, patients with PH are more likely to experience perioperative hypotension and delayed graft function [12]. Given the dismal prognosis for PH in dialysis patients, the risk factors for death must be identified to plan strategies for early intervention.…”