Beneficial effect of kidney transplantation from a deceased donor on severe chronic refractory intradialytic hypotension – a case report

BMC Nephrology

Case Report

Marek Kuźniewski¹  Alina Bętkowska-Prokop¹  Ewa Ignacak¹  Dominik Cieniawski¹  Władysław Sułowicz¹  Czesław Osuch² 

[1] Department of Nephrology, Jagiellonian University, ul. Kopernika 15C, 31-501, Krakow, Poland;First Department of Surgery, Jagiellonian University, ul. Kopernika 40, 31-501, Krakow, Poland;

关键词: Intradialytic hypotension;    Kidney transplantation;    Hemodialysis;    Case report;   

DOI  :  10.1186/s12882-017-0662-y

 received in 2016-09-09, accepted in 2017-07-12,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundChronic refractory hypotension (IDH, intradialytic hypotension) is a rare but serious problem encountered in patients on hemodialysis. Patients with chronic hypotension are often disqualified by transplant teams from renal transplantation. This is due to the possibility of an enormous risk of ischemic complications.Case presentationWe describe a 44-year old female patient with severe refractory hypotension (mean BP 60/30 mmHg, the lowest 48/28 mmHg), which appeared after bilateral laparoscopic nephrectomy of the infected kidneys. The kidney transplantation from a deceased donor, with infusion of the two pressor amines (dopamine, dobutamine) was performed without technical complications and the blood pressure measurements were 100–120/70–80 mmHg. The immunosuppression regimen was tacrolimus (TAC) + mycophenolate mophetil (MMF) and steroids (GS). Pressor amines were discontinued on the 18th day after the transplantation. Because of delayed graft function, 4 hemodialysis treatments were performed. The patient was discharged from the hospital on the 22nd day with good function of the transplanted kidney (the concentration of serum creatinine 117 μmol/l). During one-year follow-up, the patient has been remaining stable with a very good graft function (serum creatinine 84 μmol/l) and normal blood pressure (115/70 mmHg).ConclusionsProper preparation and adequate perioperative treatment allowed for safely performing kidney transplantation in the patient with severe IDH.

【 授权许可】

CC BY   
© The Author(s). 2017