Neurogenic Orthostatic Hypotension: a Common Complication of Successful Pancreas Transplantation
Background. 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. Methods. This was a nonrandomized ret...
Guardado en:
| Autores principales: | , , , , , , , , , |
|---|---|
| Formato: | article |
| Lenguaje: | EN |
| Publicado: |
Wolters Kluwer
2021
|
| Materias: | |
| Acceso en línea: | https://doaj.org/article/7d320edd7e564bdbb95fe7bc33a9bb7a |
| Etiquetas: |
Agregar Etiqueta
Sin Etiquetas, Sea el primero en etiquetar este registro!
|
| id |
oai:doaj.org-article:7d320edd7e564bdbb95fe7bc33a9bb7a |
|---|---|
| record_format |
dspace |
| spelling |
oai:doaj.org-article:7d320edd7e564bdbb95fe7bc33a9bb7a2021-11-25T07:59:57ZNeurogenic Orthostatic Hypotension: a Common Complication of Successful Pancreas Transplantation2373-873110.1097/TXD.0000000000001208https://doaj.org/article/7d320edd7e564bdbb95fe7bc33a9bb7a2021-12-01T00:00:00Zhttp://journals.lww.com/transplantationdirect/fulltext/10.1097/TXD.0000000000001208https://doaj.org/toc/2373-8731Background. 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. Methods. This was a nonrandomized retrospective single-center review of 75 SPK and 19 kidney-alone (KA) recipients with type 1 diabetes (DM). Results. OH occurred in 57 (76%) SPK versus 2 (10%) KA recipients (odds ratio [OR] 61.72, 95% confidence interval [CI], 9.69-393.01; P < 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; P = 0.03) and rapid glycemic control in the early posttransplant period (OR 1.13, 95% CI, 1.01-1.27; P = 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); P = 0.07], lower median 3-month HbA1c [4.8% (IQR 4.6–5.2) versus 5.2% (IQR 5.0–5.4); P = 0.02], and a larger reduction in HbA1c over time as compared to recipients without OH (P < 0.01). Conclusions. 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.Samantha A. Kuten, PharmDEdward A. Graviss, PhDDuc T. Nguyen, PhDA. Osama Gaber, MDArchana R. Sadhu, MDEricka P. Simpson, MDStephanie G. Yi, MDHemangshu Podder, MD, PhDAnna Kagan, MD, PhDRichard J. Knight, MDWolters KluwerarticleSurgeryRD1-811ENTransplantation Direct, Vol 7, Iss 12, p e795 (2021) |
| institution |
DOAJ |
| collection |
DOAJ |
| language |
EN |
| topic |
Surgery RD1-811 |
| spellingShingle |
Surgery RD1-811 Samantha A. Kuten, PharmD Edward A. Graviss, PhD Duc T. Nguyen, PhD A. Osama Gaber, MD Archana R. Sadhu, MD Ericka P. Simpson, MD Stephanie G. Yi, MD Hemangshu Podder, MD, PhD Anna Kagan, MD, PhD Richard J. Knight, MD Neurogenic Orthostatic Hypotension: a Common Complication of Successful Pancreas Transplantation |
| description |
Background. 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.
Methods. This was a nonrandomized retrospective single-center review of 75 SPK and 19 kidney-alone (KA) recipients with type 1 diabetes (DM).
Results. OH occurred in 57 (76%) SPK versus 2 (10%) KA recipients (odds ratio [OR] 61.72, 95% confidence interval [CI], 9.69-393.01; P < 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; P = 0.03) and rapid glycemic control in the early posttransplant period (OR 1.13, 95% CI, 1.01-1.27; P = 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); P = 0.07], lower median 3-month HbA1c [4.8% (IQR 4.6–5.2) versus 5.2% (IQR 5.0–5.4); P = 0.02], and a larger reduction in HbA1c over time as compared to recipients without OH (P < 0.01).
Conclusions. 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. |
| format |
article |
| author |
Samantha A. Kuten, PharmD Edward A. Graviss, PhD Duc T. Nguyen, PhD A. Osama Gaber, MD Archana R. Sadhu, MD Ericka P. Simpson, MD Stephanie G. Yi, MD Hemangshu Podder, MD, PhD Anna Kagan, MD, PhD Richard J. Knight, MD |
| author_facet |
Samantha A. Kuten, PharmD Edward A. Graviss, PhD Duc T. Nguyen, PhD A. Osama Gaber, MD Archana R. Sadhu, MD Ericka P. Simpson, MD Stephanie G. Yi, MD Hemangshu Podder, MD, PhD Anna Kagan, MD, PhD Richard J. Knight, MD |
| author_sort |
Samantha A. Kuten, PharmD |
| title |
Neurogenic Orthostatic Hypotension: a Common Complication of Successful Pancreas Transplantation |
| title_short |
Neurogenic Orthostatic Hypotension: a Common Complication of Successful Pancreas Transplantation |
| title_full |
Neurogenic Orthostatic Hypotension: a Common Complication of Successful Pancreas Transplantation |
| title_fullStr |
Neurogenic Orthostatic Hypotension: a Common Complication of Successful Pancreas Transplantation |
| title_full_unstemmed |
Neurogenic Orthostatic Hypotension: a Common Complication of Successful Pancreas Transplantation |
| title_sort |
neurogenic orthostatic hypotension: a common complication of successful pancreas transplantation |
| publisher |
Wolters Kluwer |
| publishDate |
2021 |
| url |
https://doaj.org/article/7d320edd7e564bdbb95fe7bc33a9bb7a |
| work_keys_str_mv |
AT samanthaakutenpharmd neurogenicorthostatichypotensionacommoncomplicationofsuccessfulpancreastransplantation AT edwardagravissphd neurogenicorthostatichypotensionacommoncomplicationofsuccessfulpancreastransplantation AT ductnguyenphd neurogenicorthostatichypotensionacommoncomplicationofsuccessfulpancreastransplantation AT aosamagabermd neurogenicorthostatichypotensionacommoncomplicationofsuccessfulpancreastransplantation AT archanarsadhumd neurogenicorthostatichypotensionacommoncomplicationofsuccessfulpancreastransplantation AT erickapsimpsonmd neurogenicorthostatichypotensionacommoncomplicationofsuccessfulpancreastransplantation AT stephaniegyimd neurogenicorthostatichypotensionacommoncomplicationofsuccessfulpancreastransplantation AT hemangshupoddermdphd neurogenicorthostatichypotensionacommoncomplicationofsuccessfulpancreastransplantation AT annakaganmdphd neurogenicorthostatichypotensionacommoncomplicationofsuccessfulpancreastransplantation AT richardjknightmd neurogenicorthostatichypotensionacommoncomplicationofsuccessfulpancreastransplantation |
| _version_ |
1718413567488688128 |