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Arterial Hypertension and Renal Allograft Survival
Kevin C. Mange, MD;
Borut Cizman, MD;
Marshall Joffe, MD, PhD;
Harold I. Feldman, MD, MSCE
JAMA. 2000;283:633-638.
Context 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.
Design Nonconcurrent historical cohort study conducted from 1985 through 1997.
Setting University teaching hospital.
Participants 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).
Main Outcome Measure 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.
Author Affiliations: Center for Clinical Epidemiology and Biostatistics and the Department of Biostatistics and Epidemiology, University of Pennsylvania Medical Center (Drs Mange, Cizman, Joffe, and Feldman), and Renal Electrolyte and Hypertension Division, Department of Medicine, University of Pennsylvania (Drs Mange, Cizman, and Feldman), Philadelphia.
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