MO969: Chronic Hypotension in Dialysis Has A Negative Impact on Kidney Transplant Outcomes

Abstract

Abstract BACKGROUND AND AIMS Persistent chronic hypotension affects 5–10% of dialysis patients, and it is associated with high morbidity and mortality [1]. Although data regarding the influence of this hemodynamic condition on kidney transplantation are scarce, some studies suggest a negative impact on kidney transplant outcomes [2-3]. We decided to analyze the evolution of patients with chronic hypotension in dialysis who undergo kidney transplantation in our center. METHOD A retrospective observational study was conducted. We evaluated 2308 consecutive kidney transplants performed at Hospital Doce de Octubre between 2004 and 2020. Sixty-six patients with chronic hypotension (defined as systolic blood pressure ≤ 100 mmHg at the time of transplantation) were identified. A control group of 66 non-hypotensive patients was assigned, matched for the source of organs and age (using as control, whenever possible, the recipient of the other kidney from the same donor). The evolution of both groups was compared in terms of primary graft function, graft thrombosis, delay in graft function, serum creatinine at the end of follow-up and renal graft survival. RESULTS Patients with chronic hypotension had higher rates of primary non-function (18.2% versus 6.1%, P = 0.033) mainly due to venous thrombosis of the renal graft (15.2% versus 3%, P = 0.015). Delayed graft function was also more common in patients with chronic hypotension (68.2% versus 50%, P< 0001). Mean graft survival was lower in the group of patients with chronic hypotension (81.1 months) compared to the control group (104.1 months) (P = 0.012). At the end of follow-up, there were 67.7% of functioning grafts within the hypotensive group compared with 86.4% in the control group (P = 0.013). Serum creatinine at the end of follow-up was slightly higher in patients with chronic hypotension (1.76 ± 0,70mg/dL versus 1.50 ± 0.49 mg/dL, P = 0.04). Median follow-up time was 37 months (1–122). In multivariate analysis, chronic hypotension was an independent risk factor for renal graft loss [RR = 2.8 (1.3–6.4), P = 0012]. CONCLUSION Chronic hypotension in dialysis has a negative impact in short and long-term kidney transplant outcomes. It is associated with higher rates of primary non-function due to venous graft thrombosis, higher rates of delayed graft function, a higher serum creatinine at the end of follow-up and a worse renal graft survival. It seems crucial to identify this subgroup of patients in order to implement measures aimed to ameliorate transplant results.