Blood Pressure Goals and Outcomes in Kidney Transplant Recipients in an Analysis of the Collaborative Transplant Study
Introduction: Hypertension is an independent risk factor for cardiovascular disease, the leading cause of death in kidney transplant recipients. However, optimal blood pressure targets posttransplant remain uncertain. We investigated the impact of different American College of Cardiology and the Ame...
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Elsevier
2025-03-01
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| Series: | Kidney International Reports |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S246802492403403X |
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| author | Claudius Speer Louise Benning Christian Morath Martin Zeier Norbert Frey Gerhard Opelz Bernd Döhler Thuong Hien Tran |
| author_facet | Claudius Speer Louise Benning Christian Morath Martin Zeier Norbert Frey Gerhard Opelz Bernd Döhler Thuong Hien Tran |
| author_sort | Claudius Speer |
| collection | DOAJ |
| description | Introduction: Hypertension is an independent risk factor for cardiovascular disease, the leading cause of death in kidney transplant recipients. However, optimal blood pressure targets posttransplant remain uncertain. We investigated the impact of different American College of Cardiology and the American Heart Association (ACC/AHA) blood pressure categories on graft survival and patient mortality, and analyzed subgroup-specific effects. Methods: This large-scale retrospective study included 1-year blood pressure data from 62,556 kidney transplant recipients across 209 centers in 39 countries, using the collaborative transplant study (CTS) database. Primary outcomes were death-censored graft failure and patient mortality during first 6 years posttransplantation. Multivariable Cox regression analysis controlled for multiple immunological and nonimmunological confounders. Results: At 1 year posttransplant, 77% of kidney transplant recipients had hypertension. We did not find a significant difference in death-censored graft failure and patient mortality between patients with normal blood pressure (< 120/< 80 mm Hg) and those with elevated blood pressure (120–129/< 80 mm Hg). Hypertension stages 1 (130–139/80–89 mm Hg) and 2 (≥ 140/≥ 90 mm Hg) were associated with an 11% and 55% increased risk of death-censored graft failure, respectively. Patient mortality was only significantly increased in those with hypertension stage 2. Kidney transplant recipients with hypertension stage 2 continued to have an increased risk of graft failure, even when they achieved normal blood pressure in the second year posttransplant. Certain subgroups of patients were at particularly high risk of detrimental effects of high blood pressure. Conclusion: This study highlights the negative impact of hypertension early after kidney transplantation and emphasizes the importance of effective treatment to improve long-term graft and patient survival. |
| format | Article |
| id | doaj-art-1383c92534eb40eabddefb6fbb45f30e |
| institution | Kabale University |
| issn | 2468-0249 |
| language | English |
| publishDate | 2025-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Kidney International Reports |
| spelling | doaj-art-1383c92534eb40eabddefb6fbb45f30e2025-08-20T03:45:08ZengElsevierKidney International Reports2468-02492025-03-0110378079010.1016/j.ekir.2024.12.004Blood Pressure Goals and Outcomes in Kidney Transplant Recipients in an Analysis of the Collaborative Transplant StudyClaudius Speer0Louise Benning1Christian Morath2Martin Zeier3Norbert Frey4Gerhard Opelz5Bernd Döhler6Thuong Hien Tran7Department of Nephrology, Heidelberg University Hospital, Heidelberg, Germany; Department of Internal Medicine III (Cardiology, Angiology, and Pneumology), Heidelberg University Hospital, Heidelberg, GermanyDepartment of Nephrology, Heidelberg University Hospital, Heidelberg, GermanyDepartment of Nephrology, Heidelberg University Hospital, Heidelberg, GermanyDepartment of Nephrology, Heidelberg University Hospital, Heidelberg, GermanyDepartment of Internal Medicine III (Cardiology, Angiology, and Pneumology), Heidelberg University Hospital, Heidelberg, GermanyInstitute of Immunology and Collaborative Transplant Study, Heidelberg University Hospital, Heidelberg, GermanyInstitute of Immunology and Collaborative Transplant Study, Heidelberg University Hospital, Heidelberg, GermanyInstitute of Immunology and Collaborative Transplant Study, Heidelberg University Hospital, Heidelberg, Germany; Correspondence: Thuong Hien Tran, Institute of Immunology, Im Neuenheimer Feld 305, Heidelberg, Germany.Introduction: Hypertension is an independent risk factor for cardiovascular disease, the leading cause of death in kidney transplant recipients. However, optimal blood pressure targets posttransplant remain uncertain. We investigated the impact of different American College of Cardiology and the American Heart Association (ACC/AHA) blood pressure categories on graft survival and patient mortality, and analyzed subgroup-specific effects. Methods: This large-scale retrospective study included 1-year blood pressure data from 62,556 kidney transplant recipients across 209 centers in 39 countries, using the collaborative transplant study (CTS) database. Primary outcomes were death-censored graft failure and patient mortality during first 6 years posttransplantation. Multivariable Cox regression analysis controlled for multiple immunological and nonimmunological confounders. Results: At 1 year posttransplant, 77% of kidney transplant recipients had hypertension. We did not find a significant difference in death-censored graft failure and patient mortality between patients with normal blood pressure (< 120/< 80 mm Hg) and those with elevated blood pressure (120–129/< 80 mm Hg). Hypertension stages 1 (130–139/80–89 mm Hg) and 2 (≥ 140/≥ 90 mm Hg) were associated with an 11% and 55% increased risk of death-censored graft failure, respectively. Patient mortality was only significantly increased in those with hypertension stage 2. Kidney transplant recipients with hypertension stage 2 continued to have an increased risk of graft failure, even when they achieved normal blood pressure in the second year posttransplant. Certain subgroups of patients were at particularly high risk of detrimental effects of high blood pressure. Conclusion: This study highlights the negative impact of hypertension early after kidney transplantation and emphasizes the importance of effective treatment to improve long-term graft and patient survival.http://www.sciencedirect.com/science/article/pii/S246802492403403Xblood pressuregraft survivalhypertensionkidney transplantationmortalityretrospective study |
| spellingShingle | Claudius Speer Louise Benning Christian Morath Martin Zeier Norbert Frey Gerhard Opelz Bernd Döhler Thuong Hien Tran Blood Pressure Goals and Outcomes in Kidney Transplant Recipients in an Analysis of the Collaborative Transplant Study Kidney International Reports blood pressure graft survival hypertension kidney transplantation mortality retrospective study |
| title | Blood Pressure Goals and Outcomes in Kidney Transplant Recipients in an Analysis of the Collaborative Transplant Study |
| title_full | Blood Pressure Goals and Outcomes in Kidney Transplant Recipients in an Analysis of the Collaborative Transplant Study |
| title_fullStr | Blood Pressure Goals and Outcomes in Kidney Transplant Recipients in an Analysis of the Collaborative Transplant Study |
| title_full_unstemmed | Blood Pressure Goals and Outcomes in Kidney Transplant Recipients in an Analysis of the Collaborative Transplant Study |
| title_short | Blood Pressure Goals and Outcomes in Kidney Transplant Recipients in an Analysis of the Collaborative Transplant Study |
| title_sort | blood pressure goals and outcomes in kidney transplant recipients in an analysis of the collaborative transplant study |
| topic | blood pressure graft survival hypertension kidney transplantation mortality retrospective study |
| url | http://www.sciencedirect.com/science/article/pii/S246802492403403X |
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