Arterial hypertension and renal allograft survival.
BACKGROUND
Several observational studies have investigated the significance of hypertension in renal allograft failure; however, these studies have been complicated by the lack of adjustment for baseline renal function, leaving the role of elevated blood pressure in allograft failure unclear.


OBJECTIVE
To examine the relationship between blood pressure adjusted for renal function and survival after cadaveric allograft transplantation.


METHODS
Nonconcurrent historical cohort study conducted from 1985 through 1997.


METHODS
University teaching hospital.


METHODS
A total of 277 patients aged 18 years or older who underwent cadaveric renal transplantation without another simultaneous organ transplantation and whose allograft was functioning for a minimum of 1 year. Follow-up continued through 1997 (mean follow-up, 5.7 years).


METHODS
Time to allograft failure (defined as death, return to dialysis, or retransplantation) by systolic, diastolic, and mean arterial blood pressure measurements at 1 year after transplantation.


RESULTS
Multivariate Cox proportional hazards modeling demonstrated that nonwhite ethnicity, history of acute rejection, and nondiabetic kidney disease were significant predictors of failure (P = .01 for all). In addition, the calculated creatinine clearance at 1 year had an adjusted rate ratio (RR) for allograft failure per 10 mL/min (0.17 mL/s) of 0.74 (95% confidence interval [CI], 0.62-0.88). The RR per 10-mm Hg increase in blood pressure measured at 1 year after transplantation, after adjustment for creatinine clearance, was 1.15 (95% CI, 1.02-1.30) for systolic pressure, 1.27 (95% CI, 1.01-1.60) for diastolic pressure, and 1.30 (95% CI, 1.05-1.61) for mean arterial pressure. Supplemental analyses that did not include death as a failure event or reduce the minimum allograft survival time for study subjects to 6 months yielded results consistent with the primary analysis. There was no evidence of modification of the blood pressure-allograft failure relationship by ethnicity or diabetes mellitus.


CONCLUSIONS
Systolic, diastolic, and mean arterial blood pressures at 1 year posttransplantation strongly predict allograft survival adjusted for baseline renal function. More aggressive control of blood pressure may prolong cadaveric allograft survival.
Mange
K C
KC
Center for Clinical Epidemiology and Biostatistics and the Department of Biostatistics and Epidemiology, University of Pennsylvania Medical Center, University of Pennsylvania, Philadelphia 19104-6021, USA.
Cizman
B
B
Joffe
M
M
Feldman
H I
HI
D000328:Adult; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001794:Blood Pressure; D015331:Cohort Studies; D005260:Female; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000503:physiopathology; D007165:Immunosuppression Therapy; D016030:Kidney Transplantation / Q000401:mortality*; D008297:Male; D016016:Proportional Hazards Models; D012307:Risk Factors; D016019:Survival Analysis
D000959:Antihypertensive Agents