Anesth Analg 2006;102:976
© 2006 International Anesthesia Research Society
doi: 10.1213/01.ANE.0000199180.14560.08
LETTER TO THE EDITOR
Sustained Hypertension at Reperfusion of the Transplanted Kidneys from the Non-Heart Beating Donor
Makiko Uji, MD,
Satoki Inoue, MD, and
Hitoshi Furuya, MD
Department of Anesthesiology and Division of Intensive Care, Nara Medical University, Nara, Japan, seninoue{at}naramed-u.ac.jp
To the Editor:
Hypotension is considerably more common than hypertension during reperfusion of a transplanted kidney (1). Therefore, the standard teaching regarding renal transplantation is to anticipate hypotension during graft reperfusion (2). We observed the opposite effect: two cases of sustained hypertension on graft reperfusion, both from the same non-heart-beating kidney donor.
In these two patients, anesthesia was induced with propofol and maintained with isoflurane, nitrous oxide, and fentanyl without problem. On reperfusion of the kidney, blood pressure abruptly increased from 100/60 mm Hg to 200/100 mm Hg in the first recipient and from 100/50 mm Hg to 155/80 mm Hg in the second recipient. In both cases we confirmed that there had been no unintentional administration of vasopressors. Several bolus injections of nicardipine, nitroglycerine, and landiolol, an ultra-short-acting selective ß-blocker, were used to treat the sudden hypertension, which proved refractory to treatment. Toward the end of the operation, the blood pressure in both cases gradually normalized. After stabilization of hemodynamic status, dopamine administration was started according to the institutional renal transplantation protocol. The function of the implanted kidney in both patients gradually improved and urine output increased steadily, permitting eventual withdrawal of hemodialysis.
Because both patients experienced the same hypertensive response to graft reperfusion, the cause was thought to be a hypertensive mediator present in the donor kidneys. Perhaps the compromised cardiovascular state of the non-heart-beating donor was responsible for the presence of an unidentified hypertensive mediator. Although refractory hypertension on renal graft reperfusion is rare, with increased interest in non-heart-beating donors of Western countries as well as Japan (3), refractory hypertension on graft reperfusion may become a more frequently observed phenomenon.
References
- Heino A, Orko R, Rosenberg PH. Anaesthesiological complications in renal transplantation: a retrospective study of 500 transplantations. Acta Anaesthesiol Scand 1986;30:574–80.[Medline]
- Baker J, Yost CS, Niemann CU. Organ transplantation. In: Miller RD, ed. Anesthesia, 6th ed. Philadelphia: Churchill Livingstone, 2005:2231–83.
- Kimber RM, Metcalfe MS, White SA, Nicholson ML. Use of non-heart-beating donors in renal transplantation. Postgrad Med J 2001;77:681–5.[Abstract/Free Full Text]
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