Abrupt improvement in glycemic control is known to cause treatment-induced neuoropathies in poorly-controlled diabetes (DM).¹ Similarly, neurogenic orthostatic hypotension (OH) is a well-known complication of pancreas transplantation. The purpose of this study was to characterize the incidence and timing of OH, as well as to determine the impact of glycemic control on OH development following kidney-pancreas (KP) and pancreas-alone (PA) transplantation. We performed a single-center review of 72 enteric-drained pancreas recipients from 1/2013 to 6/2016. Median age was 41 years (interquartile range (IQR) 35-50), 40 (56%) were male, 34 (47%) Caucasian, 20 (28%) African American (AA), 64 (89%) KP recipients, and 21 (29%) underwent steroid withdrawal. New-onset OH was documented in 53 (74%) patients early post-transplant (median 14 days, IQR 9-20). Treatment comprised of fludrocortisone alone (94%), or fludrocortisone and midodrine (45%). OH required readmission in 13 (25%) patients, with 5 requiring multiple readmissions. OH completely resolved in 37 of 53 (71%) recipients after a median of 1.8 months (IQR 0.9-4.2) following onset. In multivariate analysis, more rapid glycemic control [% change in HbA1c at 3 months compared to pre-transplant] was an independent predictor of OH, while AAs and younger recipients were less likely to develop OH [Table 1]. Pre-transplant HbA1c levels and glucose levels through the first 4 weeks post-transplant were similar between groups (p=NS). Our data suggests that OH is common post-pancreas transplantation and is strongly associated with more rapid glycemic control in the early post-transplant period. OH may be considered an iatrogenic complication of successful pancreas transplantation.1. Gibbons CH, Freemon R. Treatment-induced neuropathy of diabetes: an acute iatrogenic complication of diabetes. Brain 2015;138:43-52.

CITATION INFORMATION: Kuten S, Simpson E, Gaber A, Nguyen D, Graviss E, Patel S, Knight R. Neurogenic Orthostatic Hypotension: An Iatrogenic Complication of Successful Pancreas Transplantation? Am J Transplant. 2017;17 (suppl 3).

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