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Kidney transplantation in patients with severe preoperative hypertension
Maria Ajaimy1,2, Michelle Lubetzky1,2, Layla Kamal1,2
1Montefiore-Einstein Center for Transplantation, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
Insights
Severe preoperative hypertension (HTN) does not appear to be an absolute contraindication for kidney transplantation. Patients with severe HTN showed similar outcomes to those without, suggesting careful consideration for transplant eligibility.
Area of Science:
- Nephrology
- Cardiology
- Transplantation Medicine
Background:
- Severe systemic hypertension (HTN) is a known risk factor for perioperative cardiovascular complications.
- The specific impact of severe HTN on kidney transplantation (KTX) outcomes remains incompletely defined.
Purpose of the Study:
- To investigate the association between severe preoperative hypertension and outcomes in adult kidney-only transplant recipients.
Main Methods:
- A retrospective cohort study analyzed adult kidney transplant recipients from October 2009 to December 2012.
- Patients were stratified into two groups: severe preoperative HTN (SBP > 180 or DBP > 110 mmHg) and no severe HTN.
Main Results:
- Recipients with severe HTN were older and more likely to receive expanded criteria donor kidneys.
- No significant differences were observed in cardiac events, 1-year patient or graft survival, nadir creatinine, length of stay, or delayed graft function between groups.
- While some cardiac events occurred in the severe HTN group, they were not statistically different from the control group.
Conclusions:
- Severe preoperative hypertension should not be an absolute contraindication for kidney transplantation in clinically stable patients.
- Careful patient selection and management may mitigate risks associated with severe HTN in KTX recipients.
Background:
Severe systemic hypertension (HTN) is a risk factor for perioperative cardiovascular complications; however, its impact at the time of kidney transplantation (KTX) is not well defined.
Methods:
A retrospective cohort study of adult kidney-only transplant recipients between October 2009 and December 2012 was performed to examine outcomes between patients with (n = 111) and without (n = 98) severe preoperative HTN defined as SBP > 180 or DBP > 110 mmHg.
Results:
Recipients with severe HTN were older (56.7 ± 13.0 vs. 53.5 ± 12.4 yr, p = 0.07) and significantly more likely to receive an expanded criteria donor kidney (32.7% vs. 12.2%, p = 0.02). No patients developed hypertensive crisis, intracranial hemorrhage, or life threatening ventricular arrhythmias within 30 d post-transplantation; however, three patients with severe HTN had cardiac events: two with demand ischemia and one with decompensate heart failure. Two patients in the control group had decompensated heart failure. There were no differences between the groups in terms of cardiac event (2.7% vs. 2.0%, p = 0.75), one-yr patient survival (98.2% vs. 98.0%, p = 0.90) or graft survival (90.1% vs. 92.9%, p = 0.48), nadir creatinine > 2 mg/dL (4.6% vs. 6.2%, p = 0.62), length of stay > 6 d (37.8% vs. 35.7%, p = 0.75), and DGF (52.3% vs. 63.3%, p = 0.11).
Conclusions:
Our results suggest that severe preoperative HTN should not be considered an absolute contraindication to kidney transplant in patients who are otherwise clinically stable.
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