Date: Saturday, May 30, 2020
Session Time: 3:15pm-4:00pm
Presentation Time: 3:30pm-4:00pm
*Purpose: The survival of the graft in patients (px) with renal transplantation (RT) depends on multiple cardiovascular (CV) factors. With CKD progression, sympathetic activity increases, having strong impact on CV morbidity and mortality. Surgical sympathectomy and/or radiofrequency sympathectomy has shown CV benefits. The question is whether the sympathectomy generated by nephrectomy of the native kidneys is associated with an improvement in CV parameters in renal transplant (RT)
Objetive: To compare the hemodynamic and autonomic profile in RT patients (px) with nephrectomy (Nx) of the native kidneys compared with non-nephrectomised px (No).
*Methods: A cross-sectional study conducted in 123 RT px between 05/2018 and 7/2019, within a cardiovascular (CV) evaluation program performed with RT (PRECATE). Hemodynamic variables were analysed using impedance cardiography (Equipment Z logic-Exxer SA) taking into account the following variables: stroke volume (SV), heart rate (HR), systemic vascular resistance index (SVRI) and thoracic fluid content (TFC), for 3 minutes in supine position. The HR variability was analysed (for 3 minutes in supine position). Patients were classified into Nx and No. Exclusion criteria: Transplantation (Tx) time >6 months, incomplete hemodynamic analysis and limb amputation. Statistical analysis: t-student for normal distribution variables, Mann Whitney for non-normal distribution variables. Chi square for categorical variables.
*Results: 112 RT px were included (No: 95 and Nx: 17). The mean age was 54±14 a, 52.5% were male, 14% diabetic (DBT), the median Tx time and dialysis time was 59 (36-73) and 44 (30 -55) months respectively. The median SBP and DBP were 138mmHg (132-145) and 88mmHg (86-91) respectively. There were no significant differences in Tx time, age, sex, BMI, time in dialysis prior to Tx, renal function (and CKD-EPI), DBT and in antihypertensive and immunosuppressive treatment between both groups. Regarding the hemodynamic analysis, Nx arm presented lower HR (66 vs 71, p<0.038) and SVRI (2479 vs 3353 Dyn (p <0.018)), accompanied by higher SV (96 vs 74 (p> 0.027)), compared to the No arm. No differences were observed in DBP, SBP and TFC between the groups. Regarding the analysis of the autonomic variables, the low frequency component (LF) was significantly lower in Nx patients (88 vs 263 (p 0.023). Total power showed a trend (p=0.08) without reaching statistical significance.
*Conclusions: In this study cohort, the nephrectomy of native kidneys in RTx recipients improved both hemodynamic and autonomic parameters.The analysis of a greater number of renal Tx recipients will allow us to consolidate our conclusions.
To cite this abstract in AMA style:Sleiman J, Pujol GSoler, Brukman L, Laham G, Schiavone M, Castellaro C, Diaz C. Surgical Nephrectomy of the Native Kidneys: Greater Cardiovascular Benefit in Renal Transplant Recipients? [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/surgical-nephrectomy-of-the-native-kidneys-greater-cardiovascular-benefit-in-renal-transplant-recipients/. Accessed October 26, 2020.
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