Association of pre-transplant blood pressure with post-transplant outcomes

Miklos Z. Molnar, Clarence E. Foster, John J. Sim, Adam Remport, Mahesh Krishnan, Csaba P. Kovesdy, Kamyar Kalantar-Zadeh

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Background: Previous studies have indicated U-shaped associations between blood pressure (BP) and mortality in dialysis patients. We hypothesized that a similar association exists between pre-transplant BP and post-transplant outcomes in dialysis patients who undergo successful kidney transplantation. Methods: Data from the Scientific Registry of Transplant Recipients were linked to the five-yr cohort of a large dialysis organization in the United States. We identified all dialysis patients who received a kidney transplant during this period. Unadjusted and multivariate adjusted predictors of transplant outcomes were examined. Results: A total of 13 881 patients included in our study were 47 ± 14 yr old and included 42% women. There was no association between pre-transplant systolic BP and post-transplant mortality, although a decreased risk trend was observed in those with low post-dialysis systolic BP. Compared to patients with pre-dialysis diastolic BP 70 to <80 mmHg, patients with pre-dialysis diastolic BP <50 mmHg experienced lower risk of post-transplant death (hazard ratios [HR]: 0.74, 95% CI: 0.55-0.99). However, compared to patients with post-dialysis diastolic BP 70 to <80 mmHg, patients with post-dialysis diastolic BP ≥100 mmHg experienced higher risk of death (HR: 3.50, 95% CI: 1.57-7.84). In addition, very low (<50 mmHg for diastolic BP and <110 mmHg for systolic BP) pre-transplant BP was associated with lower risk of graft loss. Conclusions: Low post-dialysis systolic BP and low pre-dialysis diastolic BP are associated with lower post-transplant risk of death, whereas very high post-dialysis diastolic BP is associated with higher mortality in kidney transplant recipients. BP variations in dialysis patients prior to kidney transplantation may have a bearing on post-transplant outcome, which warrants additional studies.

Original languageEnglish
Pages (from-to)166-176
Number of pages11
JournalClinical Transplantation
Volume28
Issue number2
DOIs
Publication statusPublished - Feb 1 2014

Keywords

  • Blood pressure
  • Delayed graft function
  • Graft loss
  • Kidney transplantation
  • Mortality

ASJC Scopus subject areas

  • Transplantation

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  • Cite this

    Molnar, M. Z., Foster, C. E., Sim, J. J., Remport, A., Krishnan, M., Kovesdy, C. P., & Kalantar-Zadeh, K. (2014). Association of pre-transplant blood pressure with post-transplant outcomes. Clinical Transplantation, 28(2), 166-176. https://doi.org/10.1111/ctr.12292