Hypotension and transplant eligibility

Should low blood pressure for dialysis patients prevent them for getting kidney transplants?

It has been known that pretransplant hypotension is risk factor for delayed graft function (need for dialysis within first week of getting kidney transplant) DGF and primary nonfunction (PNF)- the transplanted renal graft not working at all.

Though at the same time, there are several cases which have also reported normalization of blood pressure after kidney transplantation.

This is one of the areas in pretransplant where patients should be informed that of higher likelihood of the transplant graft not working at all ( X3 risk) and the recipients still may end up with a starkly low kidney function (eGFR 30-35 ml/min) if the transplanted kidneys were to work at all. Plus we have added risk of infections and maligagncies on account of immunosuppression need. Some patients might still prefer this as a possiblity preferable to life on dialysis.

Underlying this discussion should be a gentle but serious reminder that HYPOTENSION perhaps is not as benign as thought of when compared to HYPERTENSION. In fact, on an emperical basis, hypotension is more difficult to diagnose and treat.

https://pmc.ncbi.nlm.nih.gov/articles/PMC11184391/

https://pmc.ncbi.nlm.nih.gov/articles/PMC11184379/