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

Authors

  • Miklos Z. Molnar,

    1. Division of Nephrology & Hypertension, University of California Irvine Medical Center, Orange, CA, USA
    2. Harold Simmons Center for Chronic Disease Research & Epidemiology, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, USA
    3. Division of Nephrology, Department of Medicine, University Health Network, University of Toronto, Toronto, ON, Canada
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  • Clarence E. Foster 3rd,

    1. Division of Transplant Surgery, University of California Irvine, Irvine, CA, USA
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  • John J. Sim,

    1. Kaiser Permanente, Los Angeles, CA, USA
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  • Adam Remport,

    1. Szent Imre Hospital, Budapest, Hungary
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  • Mahesh Krishnan,

    1. DaVita, Inc., Denver, CO, USA
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  • Csaba P. Kovesdy,

    1. Division of Nephrology, University of Tennessee, Memphis, TN, USA
    2. Division of Nephrology, Memphis VA Medical Center, Memphis, TN, USA
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  • Kamyar Kalantar-Zadeh

    Corresponding author
    1. Division of Nephrology & Hypertension, University of California Irvine Medical Center, Orange, CA, USA
    2. Harold Simmons Center for Chronic Disease Research & Epidemiology, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, USA
    3. Department of Epidemiology, UCLA School of Public Health, Los Angeles, CA, USA
    • Corresponding author: Kamyar Kalantar-Zadeh, MD, MPH, PHD, Harold Simmons Program for Kidney Disease Research & Epidemiology, Division of Nephrology & Hypertension, University of California Irvine, School of Medicine, 101 The City Drive South, City Tower, Suite 400 – ZOT: 4088, Orange, CA 92868-3217, USA.

      Tel.: 714 456 5142; fax: 714 456 6034; e-mail: kkz@uci.edu

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  • Conflict of interest: Dr. Krishnan is the employee of DaVita. Dr. Kalantar-Zadeh was the medical director of DaVita Harbor-UCLA/MFI in Long Beach, CA. Other authors have not declared any conflict of interest.

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.

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