5% of the HD population have chronic hypotension ( hypotension in the absence of volume depletion, antihypertensive medication, heart failure or cortisol deficiency). The perioperative management of these patients in the case of KTx is very challenging.

Methods: We defined severe hypotension to be BP <100 mmHg during HD and between HD sessions.

We identified 14 patients with 15 KTx (one had 2 KTx). 6 were from live donors(LD) and 9 from deceased donors (6 DBD & 3 DCD).The mean donor age was 42 years old (13-76). 2 were from expanded criteria donors(ECDs) with a history of hypertension. 3 deceased donors had acute kidney injury. The mean recipient age was 41 years old (19-69). 8 of them were on midodrine and/ or fludrocortisone. 5 of them had previous bilateral nephrectomy and 2 had unilateral nephrectomy. All patients had adoport, MMF and prednisolone for immunosuppression. The cohort included 4 iHLA Tx who treated with Therasorb and IVig before surgery and Alemtuzumab for induction. 2 other high risk recipients treated with Alemtuzumab and 8 patients treated with Basiliximab. 4 patients had 1 previous Tx, 3 had 2 previous Tx and one had 3 previous Tx. 8 of 15 KTx (53%) required ITU stay for intravenous (IV) noradrenaline to maintain BP at about 100 mmHg. 4 patients that didn't need ITU had IV Dopamine on the ward.

Results: 7 (47%) KTx had primary non function (PNF), 5 had delayed graft function (33%) and 3 (20%) primary function. 9 patients (60%) had rejection (8 AMR and one TCMR). Of the 8 functioning KTx 4 were from LD and 4 from deceased donors. The median creatinine was 153umol/L (76-253) with a follow up between 3 and 55 months. All the patients with a functioning KTx have normal BP with no need for supportive medication. 5 cases had graft nephrectomy (1st intra-operatively due to severe hypotension after reperfusion, 2nd due to renal venous thrombosis and the rest for PNF. 3 patients died (1st 45 days post Tx for sepsis, 2nd after 27 months due to MI, 3rd after 42 months due to sepsis-none of them had a functioning KTx).

Conclusion: Hypotensive patients on HD represent a complex group that needs carefull evaluation before proceeding to KTx. They need good quality kidneys that have a high chance of primary function. Because of this they should not be offered kidneys from ECDs. Such patients require multidisciplinary approach at every stage of their Tx pathway. Guidelines are in great need in this area.

CITATION INFORMATION: Manolitsi O, Kessaris N, Olsburgh J, Loukopoulos I. Outcome After Kidney Transplant (KTx) in Patients with Chronic Hypotension on Haemodialysis (HD). Am J Transplant. 2016;16 (suppl 3).

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