Pulse Pressure and Outcome in Kidney Transplantation: Results From the Collaborative Transplant Study

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Abstract

Background

Systolic (SBP) and diastolic blood pressure (DBP) are important predictors of graft and patient survival in renal transplantation. Pulse pressure (PP), the difference between systolic and diastolic pressure, has been associated with cardiovascular and renal morbidity in nontransplant epidemiological studies and clinical trials.

Methods

In this large retrospective analysis of prospectively collected data, transplant recipients from 1995 to 2015 were examined for patient and death-censored graft survival.

Results

In 43 006 recipients a higher 1-year PP was significantly associated with inferior 10-year patient and death-censored graft survival. In patients aged ≥60 SBP but not DBP was associated with 10-year survival, an effect that was pronounced in patients with a normal SBP of <140 mmHg and an increased PP of ≥60 mmHg, highlighting the superior impact of PP on survival in elderly recipients. In recipients’ ≥60 years, higher PP was associated with increased mortality due to circulatory system diseases but not to infection or cancer. The combination of PP ≥60 and high SBP ≥140 mmHg showed the strongest association with death-censored graft survival across all age groups.

Conclusions

We found convincing evidence that PP 1-year posttransplant is predictive of patient survival especially in elderly recipients with normal SBP. Combined analysis of SBP and PP showed that high PP confers additional predictive information for patient survival beyond that derived from analysis of SBP alone. With regard to prediction of death-censored graft survival, the combination of high SBP and high PP showed the best correlation across all age groups.

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