Pulmonary hypertension and post-operative outcome in renal transplant: A retrospective analysis of 170 patients

• Published in: Indian journal of anaesthesia Vol. 62; no. 2; pp. 131 - 135
• Main Authors: Goyal, Vipin, Solanki, Sohan, Baj, Birbal
• Format: Journal Article
• Language: English
• Published: India Wolters Kluwer India Pvt. Ltd 01.02.2018; Medknow Publications and Media Pvt. Ltd; Medknow Publications & Media Pvt. Ltd; Medknow Publications & Media Pvt Ltd; Wolters Kluwer Medknow Publications
• Subjects: Anesthesia; Anesthesiology; Biochemistry; Calcification; Cardiac arrhythmia; Cardiovascular disease; Care and treatment; Chronic kidney failure; Critical care; Edema; End-stage renal disease; Fistula; Health aspects; Health risk assessment; Heart surgery; hypertension; Kidney diseases; Kidney transplantation; Medical prognosis; Medical records; Multivariate analysis; Original; Patient outcomes; Patients; Peritoneal dialysis; Postoperative period; pulmonary; Pulmonary arteries; Pulmonary hypertension; Risk factors; transplantation; Transplants & implants; Ventilators; End-stage renal disease; pulmonary; hypertension; transplantation
• ISSN: 0019-5049; 0976-2817
• DOI: 10.4103/ija.IJA_529_17

Background and Aims: Renal transplant is the best possible treatment for patients suffering with end-stage renal disease (ESRD). Cardiovascular events are the commonest factors contributing to perioperative morbidity and mortality in this population. These patients have a high incidence (up to 60%) of pulmonary hypertension (PH) and that may affect the perioperative outcome. Methods: In this study, we aimed to study the impact of PH on perioperative outcome after renal transplant. PH was defined as patients with pulmonary artery systolic pressure ≥35 mmHg on pre-operative echocardiography. Medical records of 170 patients who had undergone renal transplantation in the past 3 years were reviewed. Primary outcome was delayed graft functioning and secondary outcomes were perioperative complications such as hypotension, arrhythmias, need of post-operative mechanical ventilation, atelectasis and pulmonary oedema. Results: We observed 46.5% incidence of PH in ESRD patients. Compared to patients without PH, more patients with PH had postoperative hypotension (26.58% vs. 9.89%, P = 0.004) and delayed graft functioning (8.8% vs. 1.1%, P = 0.026). On multivariate analysis, however, PH was not an independent predictor of delayed graft functioning. Conclusion: In ESRD patients, although PH is not an independent predictor of delayed graft functioning, patients having PH are more prone for perioperative hypotension and delayed graft functioning after renal transplant.