Successful kidney transplantation from a deceased donor to a recipient with chronic intradialytic hypotension (clinical case report)

Abstract

Intradialytic hypotension is a frequent complication of chronic kidney disease. According to different authors, the incidence of this condition varies in severity and being recorded in 10–70% of cases during chronic intermittent hemodialysis. The development of severe chronic intradialytic hypotension in most cases is considered as a relative contraindication to kidney transplantation due to the risk of the graft dysfunction and loss in the early postoperative period. Meanwhile, there is no consensus on the lower limit of blood pressure, which would be an absolute contraindication for kidney transplantation. In addition, patients with intradialytic hypotension have the dialysis session reduced which leads to inadequate dialysis; also, they often have such complications as thrombosis of an arteriovenous fistula, as a result of which further dialysis sessions become impossible. In such cases, renal transplantation is a risky, but lifesaving operation. We present a clinical case report of kidney allotransplantation in a female patient with a history of bilateral nephrectomy, who had been suffering from severe chronic intradialytic hypotension for three years before the operation. After allograft transplantation, her blood pressure was normalized to reference values, and the graft function fully recovered. Keywords: Kidney transplantation, Intradialytic hypotension, End-stage renal disease, Bilateral nephrectomy