Neurogenic Orthostatic Hypotension: a Common Complication of Successful Pancreas Transplantation

• Published in: Transplantation direct Vol. 7; no. 12; p. e795
• Main Authors: Kuten, Samantha A., Graviss, Edward A., Nguyen, Duc T., Gaber, A. Osama, Sadhu, Archana R., Simpson, Ericka P., Yi, Stephanie G., Podder, Hemangshu, Kagan, Anna, Knight, Richard J.
• Format: Journal Article
• Language: English
• Published: United States Lippincott Williams & Wilkins 01-12-2021; Wolters Kluwer
• Subjects: Pancreas and Islet Transplantation
• ISSN: 2373-8731; 2373-8731
• DOI: 10.1097/TXD.0000000000001208

Orthostatic hypotension (OH) is a poorly understood complication of simultaneous pancreas-kidney (SPK) transplantation. We sought to determine the incidence, timing, and relationship of OH to rapid glycemic control in the early posttransplant period.
This was a nonrandomized retrospective single-center review of 75 SPK and 19 kidney-alone (KA) recipients with type 1 diabetes (DM).
OH occurred in 57 (76%) SPK versus 2 (10%) KA recipients (odds ratio [OR] 61.72, 95% confidence interval [CI], 9.69-393.01;
< 0.001). The median onset of OH was 12 (interquartile range [IQR] 9-18) days posttransplant and resolved in 85% of SPK recipients after a median of 2.5 (IQR 1.2-6.3) months. Among SPK recipients, independent risk factors for OH were a shorter duration of DM (OR 0.85, 95% CI, 0.73-0.98;
= 0.03) and rapid glycemic control in the early posttransplant period (OR 1.13, 95% CI, 1.01-1.27;
= 0.04), as evidenced by a larger percent change in hemoglobin A1c (HbA1c) from transplant to month 3. OH patients had a higher median baseline HbA1c [8.3% (IQR 7.2-10.0) versus 7.1% (IQR 6.8-8.3);
= 0.07], lower median 3-month HbA1c [4.8% (IQR 4.6-5.2) versus 5.2% (IQR 5.0-5.4);
= 0.02], and a larger reduction in HbA1c over time as compared to recipients without OH (
< 0.01).
Our results show that OH is more likely to occur following SPK versus KA transplantation and is strongly associated with rapid glucose normalization within the early posttransplant period.