Kidney transplantation in patients with severe preoperative hypertension

Maria Ajaimy, Michelle Lubetzky, Layla Kamal, Anjali Gupta, Colin Dunn, Graciela de Boccardo, Enver Akalin, Liise Kayler

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)781-785
Number of pages5
JournalClinical Transplantation
Volume29
Issue number9
DOIs
StatePublished - Sep 1 2015

Fingerprint

Kidney Transplantation
Hypertension
Kidney
Hypertensive Intracranial Hemorrhage
Heart Failure
Graft Survival
Cardiac Arrhythmias
Length of Stay
Creatinine
Cohort Studies
Ischemia
Retrospective Studies
Transplantation
Tissue Donors
Transplants
Control Groups
Survival

Keywords

  • Complications
  • Kidney transplantation
  • Preoperative HTN

ASJC Scopus subject areas

  • Transplantation

Cite this

Ajaimy, M., Lubetzky, M., Kamal, L., Gupta, A., Dunn, C., de Boccardo, G., ... Kayler, L. (2015). Kidney transplantation in patients with severe preoperative hypertension. Clinical Transplantation, 29(9), 781-785. https://doi.org/10.1111/ctr.12579

Kidney transplantation in patients with severe preoperative hypertension. / Ajaimy, Maria; Lubetzky, Michelle; Kamal, Layla; Gupta, Anjali; Dunn, Colin; de Boccardo, Graciela; Akalin, Enver; Kayler, Liise.

In: Clinical Transplantation, Vol. 29, No. 9, 01.09.2015, p. 781-785.

Research output: Contribution to journalArticle

Ajaimy, M, Lubetzky, M, Kamal, L, Gupta, A, Dunn, C, de Boccardo, G, Akalin, E & Kayler, L 2015, 'Kidney transplantation in patients with severe preoperative hypertension', Clinical Transplantation, vol. 29, no. 9, pp. 781-785. https://doi.org/10.1111/ctr.12579
Ajaimy, Maria ; Lubetzky, Michelle ; Kamal, Layla ; Gupta, Anjali ; Dunn, Colin ; de Boccardo, Graciela ; Akalin, Enver ; Kayler, Liise. / Kidney transplantation in patients with severe preoperative hypertension. In: Clinical Transplantation. 2015 ; Vol. 29, No. 9. pp. 781-785.
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abstract = "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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AU - Akalin, Enver

AU - Kayler, Liise

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AB - 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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