Ekamol Tantisattamo

PS 08-80 IMPROVED POST-TRANSPLANT HYPERTENSION FROM NON-HYPERTENSIVE KIDNEYS: AN EXPERIENCE FROM MATE KIDNEY ANALYSES

Objective: Pathogenesis of post-transplant hypertension is complex and involve in the interplay between donors and recipients factors. Kidneys from non-hypertensive donors may be one of these main factors. Design and Method: A total of 94 kidney and/or liver-kidney transplantations from January 2015 to March 2016 were reviewed. There were 10 kidney transplant recipients who received paired deceased donor kidneys (derived from the same donor transplanted to different recipients) leading to 5 “mate” recipient pairs. Results: Of all 10 recipients, mean age was 55 years old (41–63 years old) and 7 of these were male. Mean duration of follow-up was 5.4 months (1–10 months). Up to 90% of recipients had pre-transplant hypertension. Mean post-transplant systolic blood pressure (SBP) was lower than mean pre-transplant SBP but not statistically significant (134+/−7.83 vs. 142+/−5.79, p= 0.4221) as same as mean DBP (73+/−4.43 vs. 79+/−3.51, p = 0.3349) (Table 1). Mean age of kidney donors were 42 years old (27–55 years old) and 80% were male. Up to 80% were donation after circulatory death (DCD) kidneys with an average Kidney Donor Profile Index (KDPI) of 69.4%. Donors with a history of hypertension were account for 60%. Nine out of ten recipients had pre-transplant hypertension. One non-hypertensive recipient continued to be non-hypertensive after transplantation. For the remaining 9 patients, 6 recipients became non-hypertensive after kidney transplantation, which was defined as SBP ⩽ 140, DBP ⩽ 90, or being on ⩽ 2 BP agents regardless SBP or DBP (Figure 1A). All mate recipients receiving non-hypertensive kidneys had no post-transplant hypertension; whereas, only two third of the mate recipients receiving hypertensive kidneys became non-hypertensive post-transplantation (Figure 1B). Conclusions: Kidney transplantation can improve or resolve hypertension in pre-transplant hypertensive recipients particularly utilizing kidneys from non-hypertensive donors. Since hypertension may persist in mate recipients receiving hypertensive kidneys, other recipient factors may play a more important role in the pathogenesis of post-transplant hypertension.

Living donation mitigates poorer outcomes in marginal recipients

Increasing the number of kidney transplantations results in the trend toward the utilization of marginal but acceptable kidneys for deceased donor renal transplantations (DDRT). At the same time, the acceptance of recipients with high medical, surgical, immunological, or psychosocial risks of poor transplant outcomes as we refer to here as “marginal recipients” has been increasing. The combination of both a low quality donor kidney and marginal kidney transplant recipient leads to unfavorable outcomes during the peri- and post-transplant periods. Since some of the risk factors are non-modifiable, living donor renal transplantation (LDRT) with high-quality kidneys and a well-planned operation could potentially mitigate unfavorable outcomes in high risk marginal recipients. In this article, we review common comorbid conditions and risk factors in marginal recipients. We then discuss the different outcomes between DDRT and LDRT in marginal recipients during the perioperative period and suggest potential strategies for utilizing living kidney organs to mitigate the poor outcomes of DDRT.