Abnormal BP Raises Delayed Graft Function Risk

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ORLANDO, Fla.—Low diastolic and high systolic blood pressure (BP) immediately after kidney transplantation are associated with an increased likelihood of delayed graft function (DGF), researchers reported at the National Kidney Foundation's 2013 Spring Clinical Meetings.

In a retrospective study of 183 adult kidney transplant recipients, Dhiren Kumar, MD, and colleagues at Virginia Commonwealth University in Richmond found that systolic BP above 160 mm Hg and diastolic BP below 60 mm Hg during postoperative day 0-5 were associated with a 4.3 times and 3.5 times increased likelihood of DGF.

Averaged over five days, patients with DGF had slightly lower diastolic BP compared with patients without DGF (70 vs. 74 mm Hg).

Of the 183 patients, 87 (47%) had DGF, which the researchers defined as a need for dialysis within the first week after transplantation, less than 50% reduction in serum creatinine in the first postoperative week, or both.

Other risk factors for DGF included longer cold ischemia time, older donor age, and receipt of a kidney from a donor after cardiac death.

Dr. Kumar's group observed that optimal BP management soon after kidney transplantation has not been well studied. Because allografts are unable to auto-regulate BP right away, both low and high BP could be detrimental, with high pressure resulting in endothelial injury and low pressure potentiating ischemic injury, they explained.

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