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Anesth Pain Med > Volume 10(4); 2015 > Article
Transplantation Anesthesia
Anesthesia and Pain Medicine 2015;10(4):301-307.
DOI: https://doi.org/10.17085/apm.2015.10.4.301    Published online October 31, 2015.
Severe and persistent hypotension after simultaneous nephrectomy and kidney transplantation in patients with chronic renal failure caused by polycystic kidney disease: Two cases report
Sang Hyun Hong, Jae Won Huh, Jaemin Lee
Department of Anesthesiology and Pain Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea. jmlee@catholic.ac.kr
Received: 6 March 2015   • Revised: 7 April 2015   • Accepted: 26 May 2015
Abstract
Patients with autosomal dominant polycystic kidney disease have significant morbidity due to large kidney size. Surgical extirpation of polycystic kidneys is frequently necessary to treat the morbidity or to obtain intraabdominal space for a graft kidney. Simultaneous bilateral nephrectomy and kidney transplantation are performed in many transplant centers to avoid the complications associated with anephric states such as anemia requiring blood transfusion, osteodystrophy, fluid overload, hyperkalemia, and congestive heart failure. However, the risk of postoperative complications after combined bilateral nephrectomy with kidney transplantation is relatively high, especially for cases in which the polycystic kidneys are huge. Here, we report two cases of severe and persistent hypotension during and after combined surgery which may have been caused by adrenal insufficiency or by sympathetic denervation and splanchnic vasculature decompression after the removal of huge polycystic kidneys.
Key Words: Hypotension, Kidney transplantation, Nephrectomy, Polycystic kidney disease


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