Donor hypertension worsens graft survival, function in kidney recipients

Kidney transplant recipients from living donors with hypertension are at significantly increased risk of renal allograft loss compared to those from normotensive living donors, reveals a study. Moreover, outcomes are similar to recipients of normotensive deceased donors.

The authors assessed a total of 3,907 kidney transplant recipients registered in a nationwide prospective cohort from 2014 to 2018. They divided patients by donor types and the presence of donor hypertension. Occurrence of death-censored graft failure was the primary outcome, while renal allograft function was secondary.

Hypertension prevalence was 9.4 percent (258/2,740) in living donors and 19.9 percent (232/1,167) in deceased ones. The rate of death-censored graft survival was notably lower among recipients of hypertensive living donors than in those of normotensive living donors (p=0.008) during a median follow-up of 21.8 months.

Multivariable analysis revealed that recipients of hypertensive living donors were also at significantly higher risk of graft loss (adjusted hazard ratio, 2.91; p=0.009). Of note, no difference was seen in the risk of allograft loss between recipients of hypertensive living and normotensive deceased donors.

The worse rate of graft survival in recipients of hypertensive living donors, compared to those of normotensive living donors (p=0.027), persisted in propensity score-matched analyses, whereas no difference was noted between recipients of hypertensive living and normotensive deceased donors.

In addition, hypertension in living donors delivered a negative impact on 1-year graft function (adjusted unstandardized β, −3.64; p=0.011).