Hypertension in Kidney Transplantation Recipients: Effect on Long-term Renal Allograft Survival

Suk, Jun; Kwon, Jin Kyong; Park, Sung Bae; Kim, Hyun Chul; Cho, Won Hyun; Park, Cheol Hee

Abstract

Hypertension is a frequent complication after organ transplantation and remains risk factor for the development of cardiovascular disease and graft dysfunction after renal transplantation. The prevalence of hypertension after renal transplantation varies from 50% to 93%. There are multiple mechanisms for development of post-transplant hypertension. To examine the effects of hypertension on renal allograft survival, we studied the clinical course of 319 kidney transplant recipients(male:female=231:88, mean age=32.9+/-10.4 yrs) who had functioning graft at least 6 months. The patients were divided into three groups : normotensive groups(n=90), controlled hypertensive groups(n=176) and uncontrolled hypertensive groups(n=53). Among 319 patients, 229(72%) were hypertensive at the time of renal transplantation. The incidence of hypertension decreased progressively to 68%, 65% and 61% at 1, 3 and 5 years after transplantation (p<0.05). The numbers of antihypertensive medication at the time of operation was 1.35+/-1.09, which decreased significantly to 0.98+/-0.76 at 12 months after renal transplantation(p<0.05). Cumulative graft survival at 5 years for normotensive and controlled hypertensive patients were 44% and 50% respectively, 20% for uncontrolled hypertensive patients. The difference of 5 years graft survival between controlled hypertensive and uncontrolled hypertensive patietns was significant (p<0.01), whereas the difference between the normotensive and controlled hypertensive group was not significant. We conclude that hypertension per se may not be an important risk factor for renal graft survival. However, the control of hypertension appear to be a more important risk factor for renal allograft survivial.