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. 2024 Aug 7:37:12574.
doi: 10.3389/ti.2024.12574. eCollection 2024.

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

Hyo Jeong Kim #  1 , Kyung Won Kim #  2 , Young Su Joo  3 , Junghwa Ryu  4 , Hee-Yeon Jung  5 , Kyung Hwan Jeong  6 , Myung-Gyu Kim  7 , Man Ki Ju  8 , Seungyeup Han  9 , Jong Soo Lee  10 , Kyung Pyo Kang  11 , Han Ro  12 , Kyo Won Lee  13 , Kyu Ha Huh  14 , Myoung Soo Kim  14 , Beom Seok Kim  15 , Jaeseok Yang  15
Affiliations

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

Hyo Jeong Kim et al. Transpl Int. .

Abstract

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.

Keywords: blood pressure; graft outcome; kidney transplantation; time-varying; trajectory.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
Flowchart of the enrolled study population.
FIGURE 2
FIGURE 2
Composite outcomes according to SBP. (A) Kaplan–Meier survival curves for composite outcomes after kidney transplantation according to baseline SBP. p-value, comparison for the 110–119 mmHg group by the log-rank test. (B) Kaplan–Meier survival curves for composite outcomes after kidney transplantation according to SBP trajectory. p-value, comparison for the stable group by the log-rank test. Abbreviations: SBP, systolic blood pressure.
See this image and copyright information in PMC

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Grants and funding

The authors declare that financial support was received for the research, authorship, and/or publication of this article. This work was supported by Research Programs funded by the Korea Disease Control and Prevention Agency (2011E3300300, 2012E3301100, 2013E3301600, 2013E3301601, 2013E3301602, 2016E3300200, 2016E3300201, 2016E3300202, 2019E320100, 2019E320101, 2019E320102, 2022-11-007; 2014-ER6301-00, 2014-ER6301-01, 2014-ER6301-02, 2017-ER6301-00, 2017-ER6301-01, 2017-ER6301-02, 2020-ER7201-00, 2020-ER7201-01, 2020-ER7201-02, 2023-ER0805-00).