Orthostatic Hypotension and Concurrent Autonomic Dysfunction: A Novel Complication of Lung Transplantation
Background. Persistent orthostatic hypotension (OH) is a lesser-known complication of lung transplantation (LTx). In this retrospective case series, we describe the clinical manifestations, complications, and treatment of persistent OH in 13 LTx recipients. Methods. We identified LTx recipients who...
Saved in:
| Main Authors: | , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2022-01-01
|
| Series: | Journal of Transplantation |
| Online Access: | http://dx.doi.org/10.1155/2022/3308939 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1849403505892130816 |
|---|---|
| author | Deepika Razia Sofya Tokman Sharjeel Israr Hesham Mohamed Hesham Abdelrazek Bhuvin Buddhdev Ashwini Arjuna Kendra McAnally Samad Hashimi Michael A. Smith Ross M. Bremner Rajat Walia Ashraf Omar |
| author_facet | Deepika Razia Sofya Tokman Sharjeel Israr Hesham Mohamed Hesham Abdelrazek Bhuvin Buddhdev Ashwini Arjuna Kendra McAnally Samad Hashimi Michael A. Smith Ross M. Bremner Rajat Walia Ashraf Omar |
| author_sort | Deepika Razia |
| collection | DOAJ |
| description | Background. Persistent orthostatic hypotension (OH) is a lesser-known complication of lung transplantation (LTx). In this retrospective case series, we describe the clinical manifestations, complications, and treatment of persistent OH in 13 LTx recipients. Methods. We identified LTx recipients who underwent transplantation between March 1, 2018, and March 31, 2020, with persistent symptomatic OH and retrospectively queried the records for clinical information. Results. Thirteen patients were included in the analysis, 9 (69%) had underlying pulmonary fibrosis, and 12 (92%) were male. The median age, height, and body mass index at LTx were 68 years, 70 inches, and 27 kg/m2, respectively. Six (46%) patients were deceased at the time of chart abstraction with a median (IQR) posttransplant survival of 12.6 months (6, 21); the 7 remaining living patients were a median of 19.6 months (18, 32) posttransplant. Signs and symptoms of OH developed a median of 60 (7, 75) days after transplant. Patients were treated with pharmacological agents and underwent extensive physical therapy. Most patients required inpatient rehabilitation (n = 10, 77%), and patients commonly developed comorbid conditions including weight loss, renal insufficiency with eGFR <50 (n = 13, 100%), gastroparesis (n = 7, 54%), and tachycardia-bradycardia syndrome (n = 2, 15%). Falls were common (n = 10, 77%). The incidence of OH in LTx recipients at our center during the study period was 5.6% (13/234). Conclusions. Persistent OH is a lesser-known complication of LTx that impacts posttransplant rehabilitation and may lead to comorbidities and shortened survival. In addition, most LTx recipients with OH at our center were tall, thin men with underlying pulmonary fibrosis, which may offer an opportunity to instate pretransplant OH screening of at-risk patients. |
| format | Article |
| id | doaj-art-8ed66f42c3ec4b53b092e9528d1e02ef |
| institution | Kabale University |
| issn | 2090-0015 |
| language | English |
| publishDate | 2022-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of Transplantation |
| spelling | doaj-art-8ed66f42c3ec4b53b092e9528d1e02ef2025-08-20T03:37:16ZengWileyJournal of Transplantation2090-00152022-01-01202210.1155/2022/3308939Orthostatic Hypotension and Concurrent Autonomic Dysfunction: A Novel Complication of Lung TransplantationDeepika Razia0Sofya Tokman1Sharjeel Israr2Hesham Mohamed3Hesham Abdelrazek4Bhuvin Buddhdev5Ashwini Arjuna6Kendra McAnally7Samad Hashimi8Michael A. Smith9Ross M. Bremner10Rajat Walia11Ashraf Omar12Norton Thoracic InstituteNorton Thoracic InstituteNorton Thoracic InstituteNorton Thoracic InstituteNorton Thoracic InstituteNorton Thoracic InstituteNorton Thoracic InstituteNorton Thoracic InstituteNorton Thoracic InstituteNorton Thoracic InstituteNorton Thoracic InstituteNorton Thoracic InstituteNorton Thoracic InstituteBackground. Persistent orthostatic hypotension (OH) is a lesser-known complication of lung transplantation (LTx). In this retrospective case series, we describe the clinical manifestations, complications, and treatment of persistent OH in 13 LTx recipients. Methods. We identified LTx recipients who underwent transplantation between March 1, 2018, and March 31, 2020, with persistent symptomatic OH and retrospectively queried the records for clinical information. Results. Thirteen patients were included in the analysis, 9 (69%) had underlying pulmonary fibrosis, and 12 (92%) were male. The median age, height, and body mass index at LTx were 68 years, 70 inches, and 27 kg/m2, respectively. Six (46%) patients were deceased at the time of chart abstraction with a median (IQR) posttransplant survival of 12.6 months (6, 21); the 7 remaining living patients were a median of 19.6 months (18, 32) posttransplant. Signs and symptoms of OH developed a median of 60 (7, 75) days after transplant. Patients were treated with pharmacological agents and underwent extensive physical therapy. Most patients required inpatient rehabilitation (n = 10, 77%), and patients commonly developed comorbid conditions including weight loss, renal insufficiency with eGFR <50 (n = 13, 100%), gastroparesis (n = 7, 54%), and tachycardia-bradycardia syndrome (n = 2, 15%). Falls were common (n = 10, 77%). The incidence of OH in LTx recipients at our center during the study period was 5.6% (13/234). Conclusions. Persistent OH is a lesser-known complication of LTx that impacts posttransplant rehabilitation and may lead to comorbidities and shortened survival. In addition, most LTx recipients with OH at our center were tall, thin men with underlying pulmonary fibrosis, which may offer an opportunity to instate pretransplant OH screening of at-risk patients.http://dx.doi.org/10.1155/2022/3308939 |
| spellingShingle | Deepika Razia Sofya Tokman Sharjeel Israr Hesham Mohamed Hesham Abdelrazek Bhuvin Buddhdev Ashwini Arjuna Kendra McAnally Samad Hashimi Michael A. Smith Ross M. Bremner Rajat Walia Ashraf Omar Orthostatic Hypotension and Concurrent Autonomic Dysfunction: A Novel Complication of Lung Transplantation Journal of Transplantation |
| title | Orthostatic Hypotension and Concurrent Autonomic Dysfunction: A Novel Complication of Lung Transplantation |
| title_full | Orthostatic Hypotension and Concurrent Autonomic Dysfunction: A Novel Complication of Lung Transplantation |
| title_fullStr | Orthostatic Hypotension and Concurrent Autonomic Dysfunction: A Novel Complication of Lung Transplantation |
| title_full_unstemmed | Orthostatic Hypotension and Concurrent Autonomic Dysfunction: A Novel Complication of Lung Transplantation |
| title_short | Orthostatic Hypotension and Concurrent Autonomic Dysfunction: A Novel Complication of Lung Transplantation |
| title_sort | orthostatic hypotension and concurrent autonomic dysfunction a novel complication of lung transplantation |
| url | http://dx.doi.org/10.1155/2022/3308939 |
| work_keys_str_mv | AT deepikarazia orthostatichypotensionandconcurrentautonomicdysfunctionanovelcomplicationoflungtransplantation AT sofyatokman orthostatichypotensionandconcurrentautonomicdysfunctionanovelcomplicationoflungtransplantation AT sharjeelisrar orthostatichypotensionandconcurrentautonomicdysfunctionanovelcomplicationoflungtransplantation AT heshammohamed orthostatichypotensionandconcurrentautonomicdysfunctionanovelcomplicationoflungtransplantation AT heshamabdelrazek orthostatichypotensionandconcurrentautonomicdysfunctionanovelcomplicationoflungtransplantation AT bhuvinbuddhdev orthostatichypotensionandconcurrentautonomicdysfunctionanovelcomplicationoflungtransplantation AT ashwiniarjuna orthostatichypotensionandconcurrentautonomicdysfunctionanovelcomplicationoflungtransplantation AT kendramcanally orthostatichypotensionandconcurrentautonomicdysfunctionanovelcomplicationoflungtransplantation AT samadhashimi orthostatichypotensionandconcurrentautonomicdysfunctionanovelcomplicationoflungtransplantation AT michaelasmith orthostatichypotensionandconcurrentautonomicdysfunctionanovelcomplicationoflungtransplantation AT rossmbremner orthostatichypotensionandconcurrentautonomicdysfunctionanovelcomplicationoflungtransplantation AT rajatwalia orthostatichypotensionandconcurrentautonomicdysfunctionanovelcomplicationoflungtransplantation AT ashrafomar orthostatichypotensionandconcurrentautonomicdysfunctionanovelcomplicationoflungtransplantation |