Arterial Hypertension and Renal Allograft Survival

• Published in: JAMA : the journal of the American Medical Association Vol. 283; no. 5; pp. 633 - 638
• Main Authors: Mange, Kevin C, Cizman, Borut, Joffe, Marshall, Feldman, Harold I
• Format: Journal Article
• Language: English
• Published: Chicago, IL American Medical Association 02-02-2000
• Subjects: Adult; Antihypertensive Agents - therapeutic use; Biological and medical sciences; Blood Pressure; Cohort Studies; Female; Graft Rejection; Graft Survival; Humans; Hypertension; Hypertension - drug therapy; Hypertension - physiopathology; Immunosuppression; Kidney Transplantation - mortality; Kidneys; Male; Medical research; Medical sciences; Proportional Hazards Models; Risk Factors; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the urinary system; Survival Analysis; Transplants & implants; Human; Hypertension; Prognosis; Homograft; Predictive value; Cardiovascular disease; Graft; Survival; Kidney
• ISSN: 0098-7484; 1538-3598
• DOI: 10.1001/jama.283.5.633

CONTEXT Several observational studies have investigated the significance of
hypertension in renal allograft failure; however, these studies have been
complicated by the lack of adjustment for baseline renal function, leaving
the role of elevated blood pressure in allograft failure unclear. OBJECTIVE To examine the relationship between blood pressure adjusted for renal
function and survival after cadaveric allograft transplantation. DESIGN Nonconcurrent historical cohort study conducted from 1985 through 1997. SETTING University teaching hospital. PARTICIPANTS A total of 277 patients aged 18 years or older who underwent cadaveric
renal transplantation without another simultaneous organ transplantation and
whose allograft was functioning for a minimum of 1 year. Follow-up continued
through 1997 (mean follow-up, 5.7 years). MAIN OUTCOME MEASURE Time to allograft failure (defined as death, return to dialysis, or
retransplantation) by systolic, diastolic, and mean arterial blood pressure
measurements at 1 year after transplantation. RESULTS Multivariate Cox proportional hazards modeling demonstrated that nonwhite
ethnicity, history of acute rejection, and nondiabetic kidney disease were
significant predictors of failure (P = .01 for all).
In addition, the calculated creatinine clearance at 1 year had an adjusted
rate ratio (RR) for allograft failure per 10 mL/min (0.17 mL/s) of 0.74 (95%
confidence interval [CI], 0.62-0.88). The RR per 10-mm Hg increase in blood
pressure measured at 1 year after transplantation, after adjustment for creatinine
clearance, was 1.15 (95% CI, 1.02-1.30) for systolic pressure, 1.27 (95% CI,
1.01-1.60) for diastolic pressure, and 1.30 (95% CI, 1.05-1.61) for mean arterial
pressure. Supplemental analyses that did not include death as a failure event
or reduce the minimum allograft survival time for study subjects to 6 months
yielded results consistent with the primary analysis. There was no evidence
of modification of the blood pressure–allograft failure relationship
by ethnicity or diabetes mellitus. CONCLUSIONS Systolic, diastolic, and mean arterial blood pressures at 1 year posttransplantation
strongly predict allograft survival adjusted for baseline renal function.
More aggressive control of blood pressure may prolong cadaveric allograft
survival.