Outcomes among Recipients of Kidney Allografts from Donors with Hypertension

Allografts from living kidney donors may carry subclinical pathological abnormalities to the recipient, increasing the risk for adverse clinical outcomes. Diminished number of nephrons is one mechanism associated with hypertension. Recipients of allografts from donors with hypertension may have insufficient number of nephrons, leading to adverse outcomes associated with hyperfiltration injury.

Researchers at Johns Hopkins, Baltimore, Maryland, led by F. Al Ammary, conducted an analysis to examine change in estimated glomerular filtration rate (eGFR) over time and survival in recipients of allografts from donors with versus without hypertension, stratified by donor age. Results were reported during a virtual poster session at the American Transplant Congress 2020 in a poster titled Long-Term Outcomes in Recipients of Allografts from Living Kidney Donors with Hypertension.

The researchers utilized a national cohort of adult living-donor kidney transplantation recipients from January 1, 2005, to June 30, 2017, to identify 49,990 recipients from donors ≤50 years of age (younger), including 597 whose donors had hypertension and 21,130 recipients from donors ≥50 years of age (older), including 1441 whose donors had hypertension. Mixed models with random intercepts and random slopes and Cox regressions models adjusting for recipient, donor, and transplant characteristics were used in the analyses.

Median follow-up was 5.4 years. In the cohort of recipients from younger donors with versus without hypertension, the annual decline in eGFR was –1.10 mL/min/1.73 m² versus –0.50 mL/min/1.73 m², respectively (P<.01). The 12-year all-cause graft survival was 50.3% versus 56.0%, respectively (graft failure hazard ratio [HR] 1.21; 95% confidence interval [CI], 1.03-1.43; P=.02).

Among recipients from older donors with versus without hypertension, the annual decline in eGFR was –0.68 mL/min/1.73 m² versus –0.64 mL/min/1.73 m², respectively (P=.7). The 12-year graft survival was 50.7% versus 50.0%, respectively (graft failure HR, 1.04; 95% CI, 0.93-1.17; P=.5).

“Hypertension in younger, but not in older, donors was associated with worse recipient outcomes,” the researchers said.

Source: Ammary FAI, Yu S, Muzaale A. et al. Long-Term Outcomes in Recipients of Allografts from Living Kidney Doors with Hypertension. Abstract of a poster presented at the virtual American Transplant Congress 2020 (Abstract C-081), May 30, 2020.