Systolic blood pressure (SBP) and diastolic blood pressure (DBP) are important predictors of graft and patient survival in renal transplant recipients. Pulse pressure (PP) has been associated with cardiovascular and renal morbidity and mortality in the general population and patients with chronic kidney disease (CKD).Design and method:
Adult recipients of first deceased donor kidney grafts transplanted between 1995 and 2014 were included into the analysis for graft and patient survival if the patient had both a functioning graft and a known blood pressure reading at year 1.Results:
In 38,411 renal transplant recipients a higher PP at year 1 was significantly associated with inferior death-censored graft survival. The extent of this association was comparable to the association of DBP and SBP with death-censored graft survival. Similarly, higher PP was significantly and linearly associated with lower patient survival. However, the extent of this association was stronger for PP than for DBP or SBP. Similar results were obtained when the analysis of patient survival was restricted to death due to cardiovascular disease. In a further analysis we found, that if the SBP is >160 mmHg, the different categories of PP have no additional effect on death-censored graft survival, but if the SBP is <160 mmHg a higher PP of >70 mmHg goes along with inferior death-censored graft survival.Conclusions:
In this large retrospective analysis based on prospectively collected data from CTS, we found convincing evidence that PP 1-year posttransplant is a superior predictor of patient survival and a good predictor of death-censored graft survival in a first renal transplant recipient from a postmortal donor.