We often
encounter patients who have very low blood pressures on dialysis for unclear
reasons, perhaps there is a component of amyloidosis but functioning is normal
with these low bp in SBP 70-90s. What
happens to them when they get transplanted?
Do they have more risk of ischemic re perfusion injury, more rejection?
Or primary non function (PNF).
A recent
study in Transplantation 2011 confirms a primary non function of these grafts.
PNF is a devastating outcome after kidney transplantation and is more common
with kidneys from donors who are cardiac death or extended criteria. Recipient
criteria have not been explored. A
case-control study design and matched for the source of organ and year of
transplantation was done in this paper retrospectively. Among the factors analyzed, the mean systolic
BP , diastolic BP, and mean arterial pressure (MAP)) during the 3 months before
transplantation were significantly lower in the PNF cases compared with the
controls without PNF. The paper supports the hypothesis that the average MAP
less than or equal to 80 mm Hg during the 3 months before kidney
transplantation is a risk factor for PNF.
What does
this mean? Should we not transplant this subgroup? Should they be given
pressors prior to surgery? Should they be made volume dependent ( more then
they are perhaps) like pheochromocytoma surgeries? Unclear what those changes might do.
Check out the
full article at:
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