Association of donor hypertension and recipient renal function in living donor kidney transplantation: A single‐center retrospective study

Abstract

Transplant centers now accept living donors with well‐controlled hypertension. Little is known whether hypertension in living donors affects recipient's kidney function. We aimed to examine potential differences in kidneys from hypertensive donors compared to normotensive donors with respect to renal function over 36 months and histologic findings at transplantation (T0) and 12 months after transplantation (T1). Retrospective single‐center analysis of 174 living donor‐recipient pairs (age > 18; transplantation date 1/2008‐3/2016). Hypertension in donors was defined as being on antihypertensive medication. All biopsies were assessed by the same blinded, experienced renal pathologist. Biopsies were scored for glomerulosclerosis, IFTA, and arteriosclerosis. Regression models were used to examine the relationship of donor hypertension with renal function and histologic changes. Hypertensive donors were significantly older than normotensive donors. Chronic changes such as tubular atrophy and atherosclerosis were more evident in kidneys from hypertensive donors at T0 as well as T1. Donor hypertension was independently associated with histologic changes at T0 and T1 but not with renal function over the follow period. Despite more pronounced histologic changes in kidneys from hypertensive living donors, these grafts exhibited a similar functional outcome. However, they subsequently might be at a greater risk and warrant thorough follow‐up care.

Impact of donor hypertension on graft survival and function in living and deceased donor kidney transplantation: a nationwide prospective cohort study

“…These narrow donor criteria lead to the limited data on the outcomes of recipient of hypertensive living donors. In addition, there has been conflicting information about the impacts of donor hypertension on graft outcomes across several retrospective studies with small sample sizes [10,14,15,20,21]. A recent meta-analysis showed that donor hypertension was a weak, but significant risk factor for renal allograft failure (risk ratio of 1.31) [22].…”

“…All authors are grateful to KOTRY participating hospitals and investigators. We thank: Curie Ahn 1 , Jaeseok Yang 2 , Jin Min Kong 3 , Oh Jung Kwon 4 , Deok Gie Kim 5 , Cheol-Woong Jung 6 , Yeong Hoon Kim 7 , Joong Kyung Kim 8 , Chan-Duck Kim 9 , Ji Won Min 10 , Sung Kwang Park 11 , Yeon Ho Park 12 , Park Jae Berm 13 , Jung Hwan Park 14 , Jong-Won Park 15 , Tae Hyun Ban 16 , Sang Heon Song 17 , Seung Hwan Song 18 , Ho Sik Shin 19 , Chul Woo Yang 20 , Hye Eun Yoon 21 , Kang Wook Lee 22 , Dong Ryeol Lee 23 , Dong Won Lee 24 , Sam Yeol Lee 25 , Sang-Ho Lee 26 , Su Hyung Lee 27 , Jung Jun Lee 28 41 . in data acquisition, data analysis/interpretation, and statistical analysis.…”

Long‐term kidney function and survival in recipients of allografts from living kidney donors with hypertension: a national cohort study

“…Our findings among recipients of allografts from older donors with hypertension (mean donor age, 58 years) are consistent with prior, smaller studies. A German single‐center study ( N = 174) reported comparable allograft function three years post‐transplant in recipients whose donors had hypertension (mean donor age, 59 years) versus recipients whose donors did not have hypertension [15]. Similarly, a Japanese single‐center study ( N = 52) reported comparable allograft survival two years post‐transplant in recipients whose donors had hypertension (mean donor age, 67 years) versus recipients whose donors did not have hypertension [16].…”

“…Our study extends these inferences about allografts from older donors with hypertension with data from a large national cohort, followed up for thirteen years. Unlike prior studies where only outcomes in recipients of allografts from older donors with hypertension were investigated, [15–17] here, we additionally studied outcomes in recipients of allografts from younger donors. Our study reveals a higher risk of adverse outcomes among recipients of allografts from younger donors with hypertension (mean donor age, 42 years).…”

“…Single‐center studies have reported similar outcomes in recipients of allografts from donors with hypertension as compared with recipients of allografts from donors without hypertension [15–17]. But inferences from these studies are based on short‐term data (<3 years of follow‐up) of only recipients of allografts from older donors with hypertension and insufficiently powered statistical analyses.…”