Effect of Living Donor Kidney Transplant on Blood Pressure in Early Post-Transplant Period: Any Changes?

Background: Blood pressure is important to maintain perfusion of grafted kidney. The majority of people living with maintenance hemodialysis have high blood pressure and their arteries use to adjust organ blood flow with high blood pressure (autoregulation). The effects of living donor kidney transplant (LDKT) on blood pressure and the quantity of oral anti-hypertensive drugs required in early post-transplant period was not studied in Myanmar. Methods: A prospective observational study was conducted on 69 recipients having living donor kidney transplants. Serial blood pressure (BP) measurement was performed in the upper non-fistula arm at 4 hourly intervals (06:00 hr, 10:00 hr, 14:00 hr, 18:00 hr, 22:00 hr) in supine position by using the calibrated oscillometric device and noninvasive blood pressure (NIBP). Mean daily systolic and diastolic blood pressure (pre-transplant; one day prior to transplant) and (post-transplant; ‘Day 0’ to ‘Day 14’ post-operative period) were calculated. Serum creatinine was done daily from ‘Day 0’ to ‘Day 14’ post-operative period. Severity of high BP was categorized into 4 categories based on the level of BP; Category I was having ‘normal BP’ (≤ 135/ 85 mmHg); Category II was ‘mild’ (136/86 -160/100 mmHg); Category III was ‘moderate’ (161/101 - 180/109 mmHg); and, Category IV was ‘severe’ (≥ 181/ 110 mmHg). Results: Nearly 70% (49/69) of recipients had high BP prior to transplant though they were taking more than 3 BP lowering medication. And, fall in previously high BP was seen in 60% (41/69) in post-transplant period. The severity category of high BP changed to less severe category in two third of recipients. And nearly forty percent, 37.7% (26/69), did not require oral anti-hypertensive drugs. After transplant, the number of recipients in Category I increased from 29% (20/69) to 40.6% (28/69). And nearly forty percent of recipients, 37.7% (26/69), did not require oral anti-hypertensive drugs. In the highest BP category, Category IV, the number of recipients reduced from 2.9% (2/69) to zero percent after transplant. Nearly same number of recipients was seen in Category II; the largest group. Thirty recipients (43.5%) in pre-transplant and 29 recipients (42.0%) in post-transplant period were in Category II. The number of recipients in Category III reduced from 17 (24.6%) to 12 (17.4%) in post-transplant period. After transplant, BP of recipients in Category II and Category III was controlled with 2 anti-hypertensive drugs. And the quantity of oral anti-hypertensive drugs, number and dosage, decreased from 4 to 2 in early post-transplant period. Serum creatinine declined rapidly within the first three days; then, it reduced gradually till ‘Day 14’. Conclusion: Living donor kidney transplant decreased the severity of hypertension in 60% of living donor kidney transplant in recipients. Two third of recipients had reduced blood pressure severity category. Nearly 40% of recipients did not require oral anti-hypertensive drugs. Both number and dosage of oral anti-hypertensive drugs decreased from ‘4’ in pretransplant period to ‘2’ in early post-transplant period. Serum creatinine declined rapidly in the first three days; then, it reduced gradually till ‘Day 14’. Living donor kidney transplant reduced blood pressure as well as serum creatinine.