Background: Persistent low blood pressure after simultaneous pancreas-kidney (SPK) transplant is a known complication attributed to diabetic autonomic dysfunction.

Methods: All patients who received SPK transplants in our center between January 2010 and December 2017 and had functional pancreas graft for > 6 months were included. These patients were then divided into three groups based on active medications at the 6 months follow up: those with normal blood pressure not requiring medication (NBP-group), those on anti-hypertensive medications (HTN group) and those on medications for hypotension (fludrocortisone and/or midodrine) (hypoTN group). 

Results: A total of 199 patients met inclusion criteria: 33 (16.5%) in the NBP group, 146 (73.5%) in the HTN group and 20 (10%) in the hypoTN group. Patients in the hypoTN group were younger (p=0.02) whereas patients in the HTN group were more likely to be male (p=0.02) and have had pre-transplant HTN (p=0.04). Otherwise, demographics were similar between groups. On univariate analysis risk factors for persistent hypoTN included HLA-mismatch (HR 1.6, p=0.04) and use of lymphocyte depletion (HR 7.8, p=0.0004). On multivariate analysis adjusted for significant factors, only use of lymphocyte depleting induction was a risk factor (HR = 6, p = 0.002, 95%Cl 1.90 to 19.38). Persistent hypoTN after SPK was not associated with increased risk of death censored kidney or pancreas allograft failure on univariate (kidney p=0.8, pancreas p=0.3) or multivariate analysis (kidney HR = 0.75, p = 0.8, 95%Cl 0.08 to 5.80) or pancreas allograft loss (pancreas HR = 0.35, p = 0.3, 95%Cl 0.04 to 2.60).

Conclusion: Persistent low blood pressure after SPK appears to be associated with the use of lymphocyte-depleting induction. However, as opposed to acute hypotension related to some pathologic process, persistent low blood pressure after SPK transplants does not appear to be associated with negative long-term kidney or pancreas allograft outcomes.