Korean J Transplant.  2023 Nov;37(Suppl 1):S130. 10.4285/ATW2023.F-7140.

Resolution of hypertension after kidney transplantation is associated with better graft and patient survival in recipients with pretransplant hypertension

• Lee K
• Kim BS
• Jang M
• Jeon J
• Shin DW
• Lee JE
• Huh W
• Han KD
• Jang HR

• KMID: 2551750
• DOI: http://doi.org/10.4285/ATW2023.F-7140

Abstract

Background
Patients with advanced chronic kidney disease (CKD) are often hypertensive, and kidney transplantation (KT) can potentially lead to resolution of hypertension. Although hypertension is expected to improve in a considerable number of CKD patients after KT, little is known about the exact prevalence and prognosis of resolved hypertension following KT in patients with pretransplant hypertension.
Methods
By using Health Insurance Review & Assessment Service and Korea National Health Insurance System, KT recipients (between 2006 and 2015) who had pretransplant hypertension were identified and subsequently categorized into "persistent hypertension" or "resolved hypertension" based on their post-KT hypertension status. Cox proportional hazard model for all-cause mortality and competing-risk analysis for graft failure (with a competing event of death before graft failure) were performed after adjusting for various clinical covariates and socioeconomic status.
Results
Of the 11,342 KT recipients who had pretransplant hypertension, 8,233 patients (73%) remained hypertensive, whereas hypertension resolved in 3,109 patients (27%) after KT. Recipients with resolved hypertension had lower rates of delayed graft function and less major comorbidities, including diabetes mellitus (DM), ischemic heart disease, and stroke compared to recipients who remained hypertensive. The resolved hypertension group had 0.59-fold (95% confidence interval [CI], 0.49–0.73) lower risk for graft failure and 0.59-fold (95% CI, 0.48–0.73) lower risk for all-cause death compared to the persistent hypertension group. Subgroup analyses revealed varying effects of resolved hypertension on graft survival by sex (stronger protection in females, P for interaction=0.045) and on overall survival by DM status (weaker protection in diabetic recipients, P for interaction=0.033).
Conclusions
A substantial proportion of patients recovered from hypertension following KT, which was associated with better graft survival as well as overall patient survival. We suggest that resolution of hypertension may be used as an indicator for predicting outcomes in KT recipients.