Association between living kidney donor postdonation hypertension and recipient graft failure

Courtenay M. Holscher, Tanveen Ishaque, Christine E. Haugen, Kyle R. Jackson, Jacqueline M. Garonzik Wang, Yifan Yu, Fawaz Al Ammary, Dorry L. Segev, Allan B. Massie

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
Pages (from-to)583-590
Number of pages8
JournalTransplantation
DOIs
StatePublished - Mar 1 2020

ASJC Scopus subject areas

  • Transplantation

Fingerprint Dive into the research topics of 'Association between living kidney donor postdonation hypertension and recipient graft failure'. Together they form a unique fingerprint.

  • Cite this

    Holscher, C. M., Ishaque, T., Haugen, C. E., Jackson, K. R., Garonzik Wang, J. M., Yu, Y., Al Ammary, F., Segev, D. L., & Massie, A. B. (2020). Association between living kidney donor postdonation hypertension and recipient graft failure. Transplantation, 583-590. https://doi.org/10.1097/TP.0000000000002832