TY - JOUR
T1 - Association between Living Kidney Donor Postdonation Hypertension and Recipient Graft Failure
AU - Holscher, Courtenay M.
AU - Ishaque, Tanveen
AU - Haugen, Christine E.
AU - Jackson, Kyle R.
AU - Garonzik Wang, Jacqueline M.
AU - Yu, Yifan
AU - Al Ammary, Fawaz
AU - Segev, Dorry L.
AU - Massie, Allan B.
N1 - Publisher Copyright:
© 2020 Lippincott Williams and Wilkins. All rights reserved.
PY - 2020/3/1
Y1 - 2020/3/1
N2 - Background. Recipients of kidneys from living donors who subsequently develop end-stage renal disease (ESRD) also have higher graft failure, suggesting the 2 donor kidneys share risk factors that could inform recipient outcomes. Given that donor ESRD is rare, an earlier and more common postdonation outcome could serve as a surrogate to individualize counseling and management for recipients. Hypertension is a frequent event before donor ESRD; thus, early postdonation hypertension might indicate higher risk of graft failure. Methods. We studied Scientific Registry of Transplant Recipients data to quantify the association between early postdonation hypertension and recipient graft failure using propensity score-weighted Cox proportional hazards regression. We also examined the association between postdonation systolic blood pressure and graft failure. Results. Of 37 901 recipients, 2.4%had a donor who developed hypertension within 2 years postdonation. Controlling for donor and recipient characteristics, recipients whose donors developed hypertension had no higher risk for graft failure (adjusted hazard ratio [aHR] 1.03, 95%confidence interval [CI] 0.85-1.25, P = 0.72). This was consistent among subgroups of recipients at higher risk for adverse outcomes due to hyperfiltration: African American recipients (aHR 1.10, 95%CI 0.70-1.73, P = 0.68) and those with ESRD caused by hypertension (aHR 1.10, 95%CI 0.65-1.85, P = 0.73) or diabetes (aHR 0.80, 95%CI 0.56-1.13, P = 0.20). However, graft failure was associated with postdonation systolic blood pressure (per 10 mm Hg, aHR 1.05, 95%CI 1.03-1.08, P < 0.001). Conclusions. Although postdonation systolic blood pressure is associated with graft failure, the reported diagnosis of hypertension as determined by the requirement for blood pressure treatment early postdonation did not portend a higher risk of recipient graft failure in the same way as eventual postdonation ESRD.
AB - Background. Recipients of kidneys from living donors who subsequently develop end-stage renal disease (ESRD) also have higher graft failure, suggesting the 2 donor kidneys share risk factors that could inform recipient outcomes. Given that donor ESRD is rare, an earlier and more common postdonation outcome could serve as a surrogate to individualize counseling and management for recipients. Hypertension is a frequent event before donor ESRD; thus, early postdonation hypertension might indicate higher risk of graft failure. Methods. We studied Scientific Registry of Transplant Recipients data to quantify the association between early postdonation hypertension and recipient graft failure using propensity score-weighted Cox proportional hazards regression. We also examined the association between postdonation systolic blood pressure and graft failure. Results. Of 37 901 recipients, 2.4%had a donor who developed hypertension within 2 years postdonation. Controlling for donor and recipient characteristics, recipients whose donors developed hypertension had no higher risk for graft failure (adjusted hazard ratio [aHR] 1.03, 95%confidence interval [CI] 0.85-1.25, P = 0.72). This was consistent among subgroups of recipients at higher risk for adverse outcomes due to hyperfiltration: African American recipients (aHR 1.10, 95%CI 0.70-1.73, P = 0.68) and those with ESRD caused by hypertension (aHR 1.10, 95%CI 0.65-1.85, P = 0.73) or diabetes (aHR 0.80, 95%CI 0.56-1.13, P = 0.20). However, graft failure was associated with postdonation systolic blood pressure (per 10 mm Hg, aHR 1.05, 95%CI 1.03-1.08, P < 0.001). Conclusions. Although postdonation systolic blood pressure is associated with graft failure, the reported diagnosis of hypertension as determined by the requirement for blood pressure treatment early postdonation did not portend a higher risk of recipient graft failure in the same way as eventual postdonation ESRD.
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U2 - 10.1097/TP.0000000000002832
DO - 10.1097/TP.0000000000002832
M3 - Article
C2 - 32106202
AN - SCOPUS:85081916614
SN - 0041-1337
VL - 104
SP - 583
EP - 590
JO - Transplantation
JF - Transplantation
IS - 3
ER -