Journal List > J Korean Soc Transplant > v.30(1) > 1034499

Jo, Park, Kim, Han, Jeong, Oh, Yang, Jeon, Koo, Ha, Kwak, Hwang, and Ahn: Effect of Simultaneous Nephrectomy on Perioperative Blood Pressure and Graft Outcome in Renal Transplant Recipients with Autosomal Dominant Polycystic Kidney Disease

Abstract

Background:

For various reasons, kidney transplant recipients with autosomal dominant polycystic kidney disease (ADPKD) often undergo native nephrectomy in preparation for the transplantation. Simultaneous nephrectomy can result in hypotensive events perioperatively and affect transplant outcome adversely. Our aim was to evaluate the effect of simultaneous native nephrectomy (SNx) on perioperative blood pressure and graft outcome compared to non-nephrectomy (NNx) in renal transplant recipients with ADPKD.

Methods:

Data regarding renal function and blood pressure were collected from 42 renal transplant recipients with ADPKD. The primary outcome was graft function over 1 year post-transplant. The secondary outcomes were patient and graft survival, postoperative hypotensive events, and blood pressure control. We compared units of antihypertensive medication used by transplanted ADPKD patients in the SNx and NNx groups.

Results:

Patients with SNx during kidney transplantation showed similar rates of patient and graft survival and renal function. Although they had significantly more hypotensive events during the perioperative period (69.2% vs. 37.5% in NNx, P=0.045), no harmful influence on renal function was observed. No difference in mean blood pressure during the 1-year post-transplant period was observed between the two groups; however, the SNx group required fewer units of antihypertensive medication.

Conclusions:

SNx is a relatively safe procedure. Graft outcome in the SNx group was not inferior to that of the NNx group, and patients with SNx can have well-controlled blood pressure.

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Fig. 1.
Kaplan-Meier curves for (A) patient survival and (B) graft survival between non-nephrectomy (NNx, n=16) and simultaneous native nephrectomy (SNx, n=26) groups. P-value is estimated by log-rank test.
jkstn-30-24f1.tif
Fig. 2.
(A) Mean blood pressure (BP; mmHg, mean±SD [total no.]) and (B) units of antihypertensive medication during follow-up period after nephrectomy. Abbreviations: NNx, non-nephrectomy; SNx, simultaneous native nephrectomy. aP<0.05.
jkstn-30-24f2.tif
Table 1.
Baseline demographic and transplant-related characteristics
Characteristic Non-nephrectomy (n=16) Simultaneous nephrectomy (n=26) P-value
Age (yr) 52.4±8.6 50.2±10.4 0.485
Male sex 7 (43.8) 14 (53.8) 0.525
Hypertension 12 (75.0) 20 (76.9) >0.99
BMI (kg/m2) 23.7±4.4 22.3±2.7 0.247
Preoperative systolic blood pressure (mmHg) 137.7±17.6 131.9±14.5 0.256
Preoperative diastolic blood pressure (mmHg) 83.6±16.3 83.7±10.7 0.975
Units of antihypertensive medication 1.8±2.1 2.3±3.4 0.968
% Use
  ACE inhibitors/ARBs 37.5 50.0 0.442
  -Blockers 31.3 15.4 0.267
  Calcium channel blockers 50.0 38.5 0.475
  Diuretics 6.3 15.4 0.387
  Vasodilators 0 3.9 0.440
  1-Blockers 6.3 11.5 0.864
Donor relationship
  Living 6 (37.5) 9 (34.6) 0.85
  Deceased 10 (62.5) 17 (65.4)  
Immunosuppressive therapy
  Tacrolimus 9 (56.3) 17 (65.4) >0.99
  Cyclosporine 5 (31.2) 9 (34.6)  

Data are presented as mean±SD or number (%). Abbreviations: BMI, body mass index; ACE, angiotensin converting enzyme; ARB, angiotensin receptor blocker.

Table 2.
Perioperative clinical outcomes
Variable Non-nephrectomy (n=16) Simultaneous nephrectomy (n=26) P-value
Operative time (min) 240.6±76.6 368.1±74.5 <0.001
Estimated blood loss (mL) 500.0±364.9 719.6±432.7 0.189
RBC transfusion (units) 2.6±0.9 2.8±1.7 0.807
Cold ischemic time (min) 60.8±45.3 53.5±34.5 0.569
Urinary leakage 0 0 -
Hemorrhage 0 1 -
Thrombosis 0 1 -
Wound infection 0 0 -
Urinary stricture 0 0 -
Vascular stenosis 0 0 -
Hypotensive events 6 (37.5) 18 (69.2) 0.045

Data are presented as mean±SD or number (%). Abbreviation: RBC, red blood cell.

Table 3.
Demographic and transplant-related characteristics related to hypotensive events in the simultaneous native nephrectomy group
Variable Hypotensive events (n=18) Non-hypotensive events (n=8) P-value
Age (yr) 49.33±10.28 52.13±11.15 0.539
Male sex 9 (50) 5 (62.5) 0.683
Hypertension 12 (67) 8 (100) 0.132
BMI (kg/m2) 21.72±2.70 23.44±2.33 0.144
Preoperative systolic blood pressure (mmHg) 129.50±14.75 137.25±13.08 0.214
Preoperative diastolic blood pressure (mmHg) 83.44±9.90 84.38±13.01 0.842
Units of antihypertensive medication 2.1±2.1 2.1±3.5 0.350
% Use
  ACE inhibitors/ARBs 38.7 75.0 0.096
  -Blockers 16.7 12.5 0.796
  Calcium channel blockers 33.3 50.0 0.440
  Diuretics 11.1 25.0 0.385
  Vasodilators 5.6 0 0.516
  1-Blockers 11.1 0 0.163
Patients on >3 antihypertensive medications 4 (22.0) 2 (25.0) 0.883
Donor relationship
  Living 5 (27.7) 4 (50) 0.382
  Deceased 13 (72.2) 4 (50)  
Immunosuppressive therapy
  Tacrolimus 11 (61.1) 6 (75) 0.667
  Cyclosporine 7 (38.8) 2 (25)  

Data are presented as mean±SD or number (%). Abbreviations: BMI, body mass index; ACE, angiotensin converting enzyme; ARB, angiotensin receptor blocker.

Supplementary Table 1.
Renal function outcomes related to hypotensive events in recipients with simultaneous nephrectomy
  Non-hypotensive events (n=8) Hypotensive events (n=17) P-value
Preoperative eGFR 7.16±2.76 8.24±3.13 0.414
Post-operative 1 month eGFR 53.10±13.42 61.33±12.36 0.144
3 months eGFR 49.75±10.92 58.94±11.88 0.078
6 months eGFR 50.04±13.02 60.92±10.63 0.036
12 months eGFR 53.09±12.82 64.04±12.61 0.056

Data are presented as mean±SD. Abbreviation: eGFR, estimated glomerular filtration rate.

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