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Saudi Journal of Kidney Diseases and Transplantation
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LETTER TO EDITOR Table of Contents   
Year : 2002  |  Volume : 13  |  Issue : 1  |  Page : 63-64
Chronic Hypotension in Hemodialysis Patients: Is it a Contra-indication to Renal Transplantation?


Assistant Professor of Nephrology, Sfax University, P.O. Box 288, 3027 Sfax-Jadida, Tunisia

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How to cite this article:
Charfeddine K. Chronic Hypotension in Hemodialysis Patients: Is it a Contra-indication to Renal Transplantation?. Saudi J Kidney Dis Transpl 2002;13:63-4

How to cite this URL:
Charfeddine K. Chronic Hypotension in Hemodialysis Patients: Is it a Contra-indication to Renal Transplantation?. Saudi J Kidney Dis Transpl [serial online] 2002 [cited 2020 Jan 19];13:63-4. Available from: http://www.sjkdt.org/text.asp?2002/13/1/63/33206
To the editor:

There is a number of risk factors predis­posing to cerebro-vascular diseases in transplant patients, and these include accelerated atherosclerosis, hypertension, diabetes and disturbances in serum cholesterol and triglycerides. [1] Spontaneous intracerebral, subdural and sub-arachnoid hemorrhage have been reported in renal transplant recipients. [2] However, renal transplantation in patients suffering from chronic hypotension has never been reported. Here is the description of a dialysis patient with chronic hypotension who succumbed to cerebral hemorrhage after renal transplantation.

A 38-years-old man was admitted with one-week history of rapidly progressive renal insufficiency in February 1995. The patient underwent extensive bilateral nephrectomy with bilateral adrenalectomy due to docu­mented bilateral multifocal tubulopapillary adenocarcinoma. Afterwards, the patient was started on hemodialysis with systolic blood pressure (SBP) between 50 and 60 mm Hg, most probably related to the removal of the adrenal glands. The hypotension persisted despite adequate adrenal hormonal replacement therapy. The patient tolerated dialysis very well despite the chronic hypotension. In December 2000, after being tumor free for five years, he had a living ­related renal transplantation. During the operation, the administration of intravenous (IV) fluids and of both dopamine and dobutamine failed to raise the blood pressure. During the first three postoperative days (POD), the SBP remained lower than 60 mm Hg despite the high doses of dopamine and dobutamine and IV hydrocortisone as a replacement therapy for adrenal insuf­ficiency. On the eight POD the systolic blood pressure increased to 130 mm Hg. The urine output improved progressively on the fifth POD. Prophylactic low molecular weight heparin was administrated subcutaneously to prevent thrombosis. Two days later, the patient had symptoms of meningeal irritation, which rapidly evolved to deep coma. Cerebro-meningeal hemorrhage with effect of mass on the median structures was documented, but the patient expired on the eighth POD despite the early surgical drainage of the hematoma.

The suddenly increased SBP, even if it was maintained at a normal range (< 135 mm Hg) might have been like severe arterial hypertension for this chronically hypotensive patient and might have contributed to his cerebral hemorrhage.

So, the question then arises as to whether hemodialysis patients with chronic hypo­tension should be candidates for renal trans­plantation?

 
   References Top

1.Arvieux C, Cornforth B, Gunson B, et al. Use of grafts procured from organ transplant recipients. Transplantation 1999;67(7):1074-7.  Back to cited text no. 1    
2.Adams HP Jr, Dawson G, Coffman TJ, Corry RJ. Stroke in renal transplant recipients. ArchNeurol 1986;43:113-5.  Back to cited text no. 2    

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Correspondence Address:
Khaled Charfeddine
Assistant Professor of Nephrology, Sfax University, P.O. Box 288, 3027 Sfax-Jadida
Tunisia
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PMID: 18209416

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