Efficacy and safety of phenylephrine in the management of low systolic blood pressure after renal transplantation.
BACKGROUND
Phenylephrine can be used to treat postoperative hypotension after renal transplantation. However, its effect on the renal allograft is unknown. We evaluated the safety and efficacy of this approach.


METHODS
A retrospective cohort study of 307 renal transplant recipients between November 2005 and October 2011 was conducted, including 75 who required phenylephrine, 46 of whom were deceased donors renal transplant (DDRT) recipients and 29 who were living donor transplant (LDRT) recipients. These were compared with 75 controls matched by sex, age, type of transplant, and etiology of renal failure. The primary outcome was rate of delayed graft function (DGF). The following statistical tools were used: paired t-test for continuous data, McNemar's test for categorical data, and a nonlinear mixed decay model for change in serum creatinine (Cr).


RESULTS
Of 46 DDRT recipients who required phenylephrine, 17 developed DGF compared with 10 matched controls (relative risk [RR] 2.9, CI 1.4 to 6.0, p = 0.0040). Only one LDRT recipient required hemodialysis (DGF). No differences were noted in the number of hemodialysis treatments required (mean 2.7 in treatment group vs 3.4 in control). No significant differences were observed between phenylephrine and control groups in renal function on postoperative days 30, 90, and 365 Cr or graft survival. The immediate postoperative normalization of Cr was slower in the DDRT phenylephrine group compared with DDRT controls (p < 0.0001), but no difference in Cr was noted before discharge (p = 0.49).


CONCLUSIONS
Although there is a brief association between phenylephrine administration and a slower rate of transplanted kidney recovery, there is no clinically or statistically significant impaired outcome in the phenylephrine group at time of discharge. Administration of phenylephrine to support low blood pressure after renal transplant appears safe.
Department of Surgery, Rhode Island Hospital, Providence, RI; Brown University Alpert School of Medicine, Rhode Island Hospital, Providence, RI. Electronic address: KDay1@lifespan.org.
Kristopher M
KM
Day
Brown University Alpert School of Medicine, Rhode Island Hospital, Providence, RI.
Ross M
RM
Beckman
Brown University Alpert School of Medicine, Rhode Island Hospital, Providence, RI; Department of Biostatistics, Rhode Island Hospital, Providence, RI.
Jason T
JT
Machan
Department of Surgery, Rhode Island Hospital, Providence, RI; Brown University Alpert School of Medicine, Rhode Island Hospital, Providence, RI.
Paul E
PE
Morrissey
D016022:Case-Control Studies; D015331:Cohort Studies; D051799:Delayed Graft Function / Q000453:epidemiology; D005260:Female; D006801:Humans; D007022:Hypotension / Q000188:drug therapy*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D010656:Phenylephrine / Q000009:adverse effects / Q000627:therapeutic use*; D011183:Postoperative Complications / Q000188:drug therapy*; D012189:Retrospective Studies; D013599:Systole; D014662:Vasoconstrictor Agents / Q000627:therapeutic use*
D014662:Vasoconstrictor Agents; D010656:Phenylephrine