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Clinical Trial
. 2021 Apr 5;16(4):e0249552.
doi: 10.1371/journal.pone.0249552. eCollection 2021.

Recipient pre-existing chronic hypotension is associated with delayed graft function and inferior graft survival in kidney transplantation from elderly donors

Caterina Dolla  1 , Alberto Mella  1 , Giacinta Vigilante  1 , Fabrizio Fop  1 , Anna Allesina  1 , Roberto Presta  1 , Aldo Verri  2 , Paolo Gontero  3 , Fabio Gobbi  4 , Roberto Balagna  4 , Roberta Giraudi  1 , Luigi Biancone  1
Affiliations
Clinical Trial

Recipient pre-existing chronic hypotension is associated with delayed graft function and inferior graft survival in kidney transplantation from elderly donors

Caterina Dolla et al. PLoS One. .

Abstract

Background: Pre-existing chronic hypotension affects a percentage of kidney transplanted patients (KTs). Although a relationship with delayed graft function (DGF) has been hypothesized, available data are still scarce and inconclusive.

Methods: A monocentric retrospective observational study was performed on 1127 consecutive KTs from brain death donors over 11 years (2003-2013), classified according to their pre-transplant Mean Blood Pressure (MBP) as hypotensive (MBP < 80 mmHg) or normal-hypertensive (MBP ≥ 80 mmHg, with or without effective antihypertensive therapy).

Results: Univariate analysis showed that a pre-existing hypotension is associated to DGF occurrence (p<0.01; OR for KTs with MBP < 80 mmHg, 4.5; 95% confidence interval [CI], 2.7 to 7.5). Chronic hypotension remained a major predictive factor for DGF development in the logistic regression model adjusted for all DGF determinants. Adjunctive evaluations on paired grafts performed in two different recipients (one hypotensive and the other one normal-hypertensive) confirmed this assumption. Although graft survival was only associated with DGF but not with chronic hypotension in the overall population, stratification according to donor age revealed that death-censored graft survival was significantly lower in hypotensive patients who received a KT from >50 years old donor.

Conclusions: Our findings suggest that pre-existing recipient hypotension, and the subsequent hypotension-related DGF, could be considered a significant detrimental factor, especially when elderly donors are involved in the transplant procedure.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Graft and patient survival by DGF in the studied population.
Graft, patient, and death-censored graft survival were all reduced in patients who experienced DGF (p<0.001 in all analyses).
Fig 2
Fig 2. Renal function in studied population according to DGF occurrence.
KTs who experienced DGF had a low eGFR (CKD-EPI formula) vs. no DGF patients at any time-point. *p<0.001.
Fig 3
Fig 3. DGF incidence in the hypotensive, normotensive, and hypertensive group.
DGF incidence was higher in the hypotensive group vs. normotensive and hypertensive groups (p<0.001).
Fig 4
Fig 4. Graft and patient survival by pre-existing blood pressure status in the studied population.
No difference was noted between the hypotensive and normal-hypertensive groups (p = NS in all analyses).
Fig 5
Fig 5. Renal function in studied population according to pre-existing blood pressure status.
No difference was noted between the hypotensive and normal-hypertensive groups during the follow-up (p = N.S. at any time-point).
Fig 6
Fig 6. Death-censored graft survival by pre-existing blood pressure status and stratified by donor age.
Death-censored graft survival was reduced in patients with pre-existing hypotension who received a kidney from a donor between 51 and 66 yrs (p = 0.04) or ≥ 67 yrs (p = 0.04).
See this image and copyright information in PMC

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