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.
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