Transplant International (Aug 2024)

Impact of Blood Pressure on Allograft Function and Survival in Kidney Transplant Recipients

  • Hyo Jeong Kim,
  • Kyung Won Kim,
  • Young Su Joo,
  • Junghwa Ryu,
  • Hee-Yeon Jung,
  • Kyung Hwan Jeong,
  • Myung-Gyu Kim,
  • Man Ki Ju,
  • Seungyeup Han,
  • Jong Soo Lee,
  • Kyung Pyo Kang,
  • Han Ro,
  • Kyo Won Lee,
  • Kyu Ha Huh,
  • Myoung Soo Kim,
  • Beom Seok Kim,
  • Jaeseok Yang

DOI
https://doi.org/10.3389/ti.2024.12574
Journal volume & issue
Vol. 37

Abstract

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The optimal target blood pressure for kidney transplant (KT) patients remains unclear. We included 808 KT patients from the KNOW-KT as a discovery set, and 1,294 KT patients from the KOTRY as a validation set. The main exposures were baseline systolic blood pressure (SBP) at 1 year after KT and time-varying SBP. Patients were classified into five groups: SBP <110; 110–119; 120–129; 130–139; and ≥140 mmHg. SBP trajectories were classified into decreasing, stable, and increasing groups. Primary outcome was composite kidney outcome of ≥50% decrease in eGFR or death-censored graft loss. Compared with the 110–119 mmHg group, both the lowest (adjusted hazard ratio [aHR], 2.43) and the highest SBP (aHR, 2.25) were associated with a higher risk of composite kidney outcome. In time-varying model, also the lowest (aHR, 3.02) and the highest SBP (aHR, 3.60) were associated with a higher risk. In the trajectory model, an increasing SBP trajectory was associated with a higher risk than a stable SBP trajectory (aHR, 2.26). This associations were consistent in the validation set. In conclusion, SBP ≥140 mmHg and an increasing SBP trajectory were associated with a higher risk of allograft dysfunction and failure in KT patients.

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