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, Kyungho Lee Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul , Republic of Korea Search for other works by this author on: Oxford Academic Bong-Sung Kim Search for other works by this author on: Oxford Academic Seoin Jeong Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul , Republic of Korea Search for other works by this author on: Oxford Academic Minyoung Jang Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul , Republic of Korea Search for other works by this author on: Oxford Academic Junseok Jeon Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul , Republic of Korea Search for other works by this author on: Oxford Academic Dong Wook Shin Department of Family Medicine & Supportive Care Center, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul , Republic of Korea Search for other works by this author on: Oxford Academic Jung Eun Lee Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul , Republic of Korea Search for other works by this author on: Oxford Academic Wooseong Huh Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul , Republic of Korea Search for other works by this author on: Oxford Academic Kyungdo Han Department of Statistics and Actuarial Science, Soongsil University , Seoul , Republic of Korea Search for other works by this author on: Oxford Academic Hye Ryoun Jang Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul , Republic of Korea Search for other works by this author on: Oxford Academic
Nephrology Dialysis Transplantation, Volume 39, Issue Supplement_1, May 2024, gfae069-0967-2414, https://doi.org/10.1093/ndt/gfae069.967
Published:
23 May 2024
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Kyungho Lee, Bong-Sung Kim, Seoin Jeong, Minyoung Jang, Junseok Jeon, Dong Wook Shin, Jung Eun Lee, Wooseong Huh, Kyungdo Han, Hye Ryoun Jang, #2414 Hypertension resolution after kidney transplantation is associated with better kidney transplant outcomes in patients with pre-transplant hypertension, Nephrology Dialysis Transplantation, Volume 39, Issue Supplement_1, May 2024, gfae069–0967–2414, https://doi.org/10.1093/ndt/gfae069.967
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Abstract
Background and Aims
Hypertension is prevalent in patients with advanced chronic kidney disease (CKD), and kidney transplantation (KT) can potentially improve hypertension. Although hypertension is expected to be resolved after KT in many recipients with pre-transplant hypertension, little is known about the hypertension resolution rate and its prognostic role in KT outcomes.
Method
We retrospectively identified KT recipients (between 2006 and 2015) who had pre-transplant hypertension using Health Insurance Review & Assessment Service and Korea National Health Insurance System. The recipients were categorized into two groups based on their post-KT hypertension status: “persistent hypertension” and “resolved hypertension”. Cox proportional hazard analyses were performed to assess the risk of death-censored graft failure and all-cause mortality with adjusting various clinical, immunological risk factors, and socioeconomic status.
Results
Among 11,342 KT recipients with pre-transplant hypertension, 8,233 (73%) remained hypertensive, while 3,109 (27%) experienced hypertension resolution after KT. Recipients with resolved hypertension had lower rates of delayed graft function and major comorbidities, including diabetes mellitus, ischemic heart disease, and stroke compared to recipients who remained hypertensive. After adjusting for multiple covariates, 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 mortality compared to the persistent hypertension group. Subgroup analyses revealed that the protective effect of resolved hypertension on graft survival was more pronounced in females (P for interaction=0.045), and on overall survival was weaker in recipients with diabetes (P for interaction=0.033).
Conclusion
A significant proportion of patients experienced hypertension resolution after KT, which is associated with improved graft survival and overall patient survival. The post-KT hypertension status can be used as a prognostic indicator for predicting better outcomes in KT recipients with pre-transplant hypertension.
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© The Author(s) 2024. Published by Oxford University Press on behalf of the ERA.
This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model)
Topic:
- hypertension
- diabetes mellitus
- renal transplantation
- kidney failure, chronic
- graft survival
- health insurance
- tissue transplants
- mortality
- patient prognosis
- transplantation
- persistence
- risk reduction
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