The association of chronic kidney graft failure with recipient blood pressure.
ASN 30th Annual Meeting, San Antonio
J Am Soc Nephrol (Oct) 8:696A 1997
With the advent of new immunosuppressive regimens, the one year survival of kidney allografts has improved, however the half-life after the first year has remained unchanged. This has led many to suggest that the some of the mechanisms which lead to late graft loss may not be immunologic, but rather may be analogous to those which lead to progressive loss of native kidney function in renal diseases. ( Bia, Kidney International, 47:1470, 1995). These include hypertension, which accelerates renal failure, perhaps in part by it's effect on glomerular hemodynamics and blood vessel morphology.
Opelz et al. studied the influence of blood pressure on graft function in a large registry of transplant patients. 29,751 patients were studied over 7 years. Systolic and diastolic hypertension were associated with increased rates of graft loss. This effect was not due to patient death and was seen in both cadaveric and live donor transplants. The contribution of hypertension was independent of graft function and occurred in the absence of documented acute rejection.
Comment: Opelz et al. have documented a strong correlation of blood pressure with graft survival, independent of other variables. In contrast to native kidney disease, in which many regard ACE inhibitors as the treatment of choice, the relative efficacy of various anti-hypertensives in slowing chronic allograft dysfunction is unclear. As the authors point out, recommendations regarding the choice of antihypertensives and the aggressiveness with which blood pressure should be lowered awaits a prospective trial. (Judith Benstein, M.D., NYU University Hospital, New York, NY)
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ASN 30th Annual Meeting, San Antonio
Transplant : Transplantation