Blood pressure and graft outcome in renal transplantation.
To investigate the effects of blood pressure (BP) on kidney function, we reviewed 116 patients who had a median follow-up of 40.5 months. Systolic and diastolic hypertension (HTN) at month 6 resulted in significantly higher serum creatinine (SCr) levels at 1 year, compared with patients with normal BP, namely, 2.2 versus 1.4 mg/dL (P = .0001) and 1.87 versus 1.5 mg/dL (P = .04), respectively. Mean systolic and diastolic BP at the end of 1 and 6 months were significantly higher among patients who had returned to hemodialysis or who had an SCr > or =2 mg/dL at their last follow-up. Mean age, mean donor age, donor type, and sex had no significant effect on graft function. Patients receiving Rapamune-based treatment (n = 9) had no graft failure; graft outcomes were similar between cyclosporine-based and tacrolimus-based immunosuppression therapy. Patients with biopsy-proved acute rejection showed significantly lower graft survival. By multivariate analysis, systolic HTN at the end of 1 month (P = .006) and 6 months (P = .01), and diastolic HTN at the end of 6 months (P = .04) were independent risk factors for graft outcome. Actuarial 5-year graft survival was 95%, versus 76% in patients with normal BP versus systolic HTN at 1 month, respectively (P = .02). A significant difference in 5-year graft survival was observed between patients with normal diastolic BP and diastolic HTN at 6 months (95% versus 67%, respectively; P = .001). Since systolic and diastolic BP at different times before and after transplantation correlate with graft function, more attention should be paid to maintain normal BP in patients with renal transplants.
Berber
I
I
Haydarpasa Numune Research and Training Hospital, Istanbul, Turkey. iberber@hotmail.com
Aydin
C
C
Yigit
B
B
Kara
V M
VM
Yildar
M
M
Duzyol
C
C
Turkmen
F
F
Titiz
M I
MI
Altaca
G
G
D000293:Adolescent; D000328:Adult; D001794:Blood Pressure / Q000502:physiology*; D002648:Child; D003971:Diastole / Q000502:physiology; D005260:Female; D006085:Graft Survival / Q000502:physiology; D006801:Humans; D016030:Kidney Transplantation / Q000401:mortality / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D012189:Retrospective Studies; D016019:Survival Analysis; D013599:Systole / Q000502:physiology; D016896:Treatment Outcome