Khurana Anand, McCuskey Charles F, Slavcheva Elena G
Department of Nephrology, Texas A&M University, Temple, TX 76508, USA.
Exp Clin Transplant. 2008 Jun;6(2):127-31.
Orthostatic hypotension is a known complication of pancreas transplant. This retrospective study of 25 kidney-pancreas transplant patients at our center was done to determine the incidence and course of postoperative orthostatic hypotension.
A chart review was done for all patients who received a kidney-pancreas transplant between January 1997 and December 2005. Patients with orthostatic hypotension after surgery were selected and compared with patients without orthostatic hypotension for preexisting autonomic and peripheral neuropathy status. The kidney-pancreas transplant group was then compared with a group of diabetic kidney-only transplant recipients to assess the contribution of the renal transplant in this process.
Seven kidney-pancreas transplant patients (28%) developed orthostatic hypotension after the transplant. It occurred with much higher frequency in kidney-pancreas transplant patients than it did in kidney transplant patients (P = .002). The onset of orthostatic hypotension was between 8 and 20 days after transplant. Six patients required midodrine for symptomatic relief. Orthostasis resolved completely within 3 weeks to 9 months in all but 1 patient. There was no correlation between postoperative orthostasis and preoperative history of orthostatic hypotension, gastroparesis, or peripheral neuropathy. Orthostasis was related to posttransplant polyuria in only 1 patient. In the remaining patients, orthostasis seemed to be related to the presence of the pancreas transplant. The exact pathogenesis of orthostasis is unclear but may be related to hyperinsulinemia after transplant or neuropeptides involved in the regenerative process.
Orthostatic hypotension is common after kidney-pancreas transplant. It is unrelated to preexisting autonomic neuropathy or posttransplant polyuria in most patients. This complication requires further study.
体位性低血压是胰腺移植已知的并发症。本研究对我院中心25例肾胰腺移植患者进行回顾性研究，以确定术后体位性低血压的发生率及病程。
对1997年1月至2005年12月期间接受肾胰腺移植的所有患者进行病历回顾。选取术后发生体位性低血压的患者，并与无体位性低血压的患者比较其术前自主神经和周围神经病变情况。然后将肾胰腺移植组与一组仅接受糖尿病肾病移植的受者进行比较，以评估肾移植在此过程中的作用。
7例肾胰腺移植患者（28%）术后发生体位性低血压。其在肾胰腺移植患者中的发生率远高于肾移植患者（P = 0.002）。体位性低血压发生在移植后8至20天。6例患者需要使用米多君缓解症状。除1例患者外，所有患者的体位性低血压在3周内至9个月内完全缓解。术后体位性低血压与术前体位性低血压、胃轻瘫或周围神经病变病史无相关性。仅1例患者的体位性低血压与移植后多尿有关。在其余患者中，体位性低血压似乎与胰腺移植的存在有关。体位性低血压的确切发病机制尚不清楚，但可能与移植后高胰岛素血症或再生过程中涉及的神经肽有关。
肾胰腺移植后体位性低血压很常见。在大多数患者中，它与术前自主神经病变或移植后多尿无关。这一并发症需要进一步研究。
