title: Hypertension in standard criteria deceased donors is associated with inferior outcomes following kidney transplantation.
abstract: BACKGROUND
  Hypertension may be a either a cause or an effect of kidney disease. Although hypertension is an important component of the expanded criteria donor definition, risks of transplanting deceased donor kidneys from hypertensive standard criteria donors (SCD) are less well understood.
  
  
  METHODS
  Retrospective single-center study in all adult patients who received a deceased donor kidney transplant from a SCD to evaluate the role of donor hypertension as a pre-transplant risk factor for death-censored graft loss (DCGL) and renal function.
  
  
  RESULTS
  From October 2001 through May 2008, 297 kidney transplants were performed from donation after brain death SCDs. A total of 47 (15.8%) grafts were lost, including 19 (6.4%) deaths with functioning grafts. Univariate analysis of death-censored cases (n = 278) identified history of donor hypertension, cold ischemia time (CIT) >30 h, and African American (AA) recipients as significant pre-transplant risk factors predictive for DCGL at five yr follow-up (mean 38 months, all p < 0.02). Cox regression analysis showed donor hypertension (relative risk 2.2, p = 0.04) to be a significant risk factor for DCGL, whereas CIT >30 h and AA recipient ethnicity showed only trends toward DCGL. Renal function as determined by serum creatinine levels was significantly higher in recipients of hypertensive compared with non-hypertensive SCD kidneys at all time points out to 48 months follow-up and the disparity in renal function increased over time.
  
  
  CONCLUSIONS
  Transplanting SCD kidneys from hypertensive donors is associated with worse graft function and an increased risk of graft loss.
authors.affiliation: Department of General Surgery, Wake Forest University School of Medicine, Winston-Salem, NC, USA. rpss27@yahoo.co.uk
authors.forename: Rajinder P
authors.initials: RP
authors.lastname: Singh
authors.forename: Alan C
authors.initials: AC
authors.lastname: Farney
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Rogers
authors.forename: Michael
authors.initials: M
authors.lastname: Gautreaux
authors.forename: Amber
authors.initials: A
authors.lastname: Reeves-Daniel
authors.forename: Erica
authors.initials: E
authors.lastname: Hartmann
authors.forename: William
authors.initials: W
authors.lastname: Doares
authors.forename: Samy
authors.initials: S
authors.lastname: Iskandar
authors.forename: Patricia
authors.initials: P
authors.lastname: Adams
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Stratta
mesh_terms: D000328:Adult; D002102:Cadaver; D015331:Cohort Studies; D003404:Creatinine / Q000097:blood; D005260:Female; D006084:Graft Rejection / Q000209:etiology*; D006801:Humans; D006973:Hypertension / Q000209:etiology*; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015996:Survival Rate; D014019:Tissue Donors; D016896:Treatment Outcome
chemical_list: D003404:Creatinine