Title : Effect of renal transplantation on severe TR and severe PAH in a patient with end stage renal disease
Abstract:
Statement of the Problem: End-stage renal disease (ESRD) is strongly associated with an elevated incidence of pulmonary arterial hypertension (PAH), which significantly contributes to increased mortality, morbidity. PAH resulting from aetiologies other than left-sided heart disease, such as idiopathic PAH and PAH secondary to chronic kidney disease (CKD), can lead to the development of tricuspid regurgitation (TR) due to increased right ventricular (RV) afterload, RV dilation, and dysfunction.
Methodology: We present a case of a patient with severe PAH and TR who was scheduled for a living donor renal transplantation. A 21year old male, weighing 54 kg with ESRD with systemic hypertension belonging to NYHA grade IV was scheduled for renal transplantation. He was on maintenance hemodialysis twice a week through left arteriovenous fistula (AV) since 2018 having history of orthopnea and PND. We had monitored this patient with Flo Trac monitor. We assessed SV, stroke volume variation (SVV), SVR, CO, cardiac index (CI) and CVP, to evaluate hemodynamic stability and guide appropriate treatment to augment vascular volume, fluid administration, reduce anesthetic administration or use of vasopressors or inotropes.
Findings: The focus of this report is on the importance of meticulous anaesthetic management and the impact of renal transplantation on the improvement of PAH and severe TR. After successful renal transplantation, on postoperative day 1, symptoms of fluid overload subsided. On postoperative day 3, PASP came down to 54 mmHg from 84 mm Hg preoperatively and TR becomes moderate on Echocardiographic findings. Finally at postoperative day 10, PASP comes down to 40 mm HG and TR became of mild state.
Conclusion: By this report we can conclude that in ESRD patients with severe PAH and severe TR, renal transplantation can revert the altered pathophysiology that causes PAH and TR.
