Elevated blood pressure predicts the risk of acute rejection in renal allograft recipients

Fernando G Cosio, R. P. Pelletier, T. E. Pesavento, M. L. Henry, R. M. Ferguson, L. Mitchell, S. Lemeshow

Research output: Contribution to journalArticle

44 Citations (Scopus)

Abstract

Background. Acute rejection (AR) is a strong predictor of renal allograft survival. Recent advances in immunosuppression have reduced considerably the incidence of AR. Still, approximately 25% of patients have AR early post-transplant, and the factors that predispose to AR have not been fully clarified. Methods. The study includes 1641 adults, recipients of first cadaveric (CAD, N = 1195) or living related renal grafts (LRD, N = 446), transplanted in one institution. The variables associated with the occurrence of AR during the first year post-transplant were identified. Results. By univariate analyses, AR was associated with the following variables: younger (P < 0.001); heavier (P = 0.003); and African American recipients (P = 0.002); CAD transplants (P = 0.001); higher number of HLA mismatches (P = 0.001); delayed graft function (DGF, P = 0.001); higher levels of serum creatinine post-transplant (P = 0.003); and higher levels of systolic and/or diastolic blood pressure (BP) post-transplant (P < 0.001). Higher BP levels were also associated with earlier AR episodes (P < 0.0001). By multivariable analysis AR was significantly associated with recipient age, number of HLA mismatches, DGF, pre-PRA and systolic BP. Analysis of BP measured weekly post-transplant indicated that elevated BP levels, even three weeks prior to the AR episode, were significantly associated with AR. For every level of BP, the use of BP medications was associated with a lower incidence of AR (P < 0.0001). Furthermore, the use of calcium channel blockers was also associated with lower incidence of AR (P = 0.001). Of note, 81% of recipients whose BP increased after the transplant had AR. In contrast, 22% of patients whose BP declined post-transplant had AR. Conclusions. Elevated BP levels post-transplant identify patients at high risk of AR independently of graft function. Treatment of BP and reduction of BP levels appears to be associated with a decreased risk of AR. We hypothesize that high BP may be an indicator of a particular type of allograft damage, perhaps ischemic, that may predispose to AR.

Original languageEnglish (US)
Pages (from-to)1158-1164
Number of pages7
JournalKidney International
Volume59
Issue number3
DOIs
StatePublished - 2001
Externally publishedYes

Fingerprint

Allografts
Blood Pressure
Kidney
Transplants
Incidence
Delayed Graft Function
Hypertension
Calcium Channel Blockers
Graft Rejection
African Americans
Immunosuppression
Creatinine

Keywords

  • Blood pressure
  • BP medications
  • Calcium channel blockers
  • Renal transplantation

ASJC Scopus subject areas

  • Nephrology

Cite this

Cosio, F. G., Pelletier, R. P., Pesavento, T. E., Henry, M. L., Ferguson, R. M., Mitchell, L., & Lemeshow, S. (2001). Elevated blood pressure predicts the risk of acute rejection in renal allograft recipients. Kidney International, 59(3), 1158-1164. https://doi.org/10.1046/j.1523-1755.2001.0590031158.x

Elevated blood pressure predicts the risk of acute rejection in renal allograft recipients. / Cosio, Fernando G; Pelletier, R. P.; Pesavento, T. E.; Henry, M. L.; Ferguson, R. M.; Mitchell, L.; Lemeshow, S.

In: Kidney International, Vol. 59, No. 3, 2001, p. 1158-1164.

Research output: Contribution to journalArticle

Cosio, FG, Pelletier, RP, Pesavento, TE, Henry, ML, Ferguson, RM, Mitchell, L & Lemeshow, S 2001, 'Elevated blood pressure predicts the risk of acute rejection in renal allograft recipients', Kidney International, vol. 59, no. 3, pp. 1158-1164. https://doi.org/10.1046/j.1523-1755.2001.0590031158.x
Cosio, Fernando G ; Pelletier, R. P. ; Pesavento, T. E. ; Henry, M. L. ; Ferguson, R. M. ; Mitchell, L. ; Lemeshow, S. / Elevated blood pressure predicts the risk of acute rejection in renal allograft recipients. In: Kidney International. 2001 ; Vol. 59, No. 3. pp. 1158-1164.
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abstract = "Background. Acute rejection (AR) is a strong predictor of renal allograft survival. Recent advances in immunosuppression have reduced considerably the incidence of AR. Still, approximately 25{\%} of patients have AR early post-transplant, and the factors that predispose to AR have not been fully clarified. Methods. The study includes 1641 adults, recipients of first cadaveric (CAD, N = 1195) or living related renal grafts (LRD, N = 446), transplanted in one institution. The variables associated with the occurrence of AR during the first year post-transplant were identified. Results. By univariate analyses, AR was associated with the following variables: younger (P < 0.001); heavier (P = 0.003); and African American recipients (P = 0.002); CAD transplants (P = 0.001); higher number of HLA mismatches (P = 0.001); delayed graft function (DGF, P = 0.001); higher levels of serum creatinine post-transplant (P = 0.003); and higher levels of systolic and/or diastolic blood pressure (BP) post-transplant (P < 0.001). Higher BP levels were also associated with earlier AR episodes (P < 0.0001). By multivariable analysis AR was significantly associated with recipient age, number of HLA mismatches, DGF, pre-PRA and systolic BP. Analysis of BP measured weekly post-transplant indicated that elevated BP levels, even three weeks prior to the AR episode, were significantly associated with AR. For every level of BP, the use of BP medications was associated with a lower incidence of AR (P < 0.0001). Furthermore, the use of calcium channel blockers was also associated with lower incidence of AR (P = 0.001). Of note, 81{\%} of recipients whose BP increased after the transplant had AR. In contrast, 22{\%} of patients whose BP declined post-transplant had AR. Conclusions. Elevated BP levels post-transplant identify patients at high risk of AR independently of graft function. Treatment of BP and reduction of BP levels appears to be associated with a decreased risk of AR. We hypothesize that high BP may be an indicator of a particular type of allograft damage, perhaps ischemic, that may predispose to AR.",
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T1 - Elevated blood pressure predicts the risk of acute rejection in renal allograft recipients

AU - Cosio, Fernando G

AU - Pelletier, R. P.

AU - Pesavento, T. E.

AU - Henry, M. L.

AU - Ferguson, R. M.

AU - Mitchell, L.

AU - Lemeshow, S.

PY - 2001

Y1 - 2001

N2 - Background. Acute rejection (AR) is a strong predictor of renal allograft survival. Recent advances in immunosuppression have reduced considerably the incidence of AR. Still, approximately 25% of patients have AR early post-transplant, and the factors that predispose to AR have not been fully clarified. Methods. The study includes 1641 adults, recipients of first cadaveric (CAD, N = 1195) or living related renal grafts (LRD, N = 446), transplanted in one institution. The variables associated with the occurrence of AR during the first year post-transplant were identified. Results. By univariate analyses, AR was associated with the following variables: younger (P < 0.001); heavier (P = 0.003); and African American recipients (P = 0.002); CAD transplants (P = 0.001); higher number of HLA mismatches (P = 0.001); delayed graft function (DGF, P = 0.001); higher levels of serum creatinine post-transplant (P = 0.003); and higher levels of systolic and/or diastolic blood pressure (BP) post-transplant (P < 0.001). Higher BP levels were also associated with earlier AR episodes (P < 0.0001). By multivariable analysis AR was significantly associated with recipient age, number of HLA mismatches, DGF, pre-PRA and systolic BP. Analysis of BP measured weekly post-transplant indicated that elevated BP levels, even three weeks prior to the AR episode, were significantly associated with AR. For every level of BP, the use of BP medications was associated with a lower incidence of AR (P < 0.0001). Furthermore, the use of calcium channel blockers was also associated with lower incidence of AR (P = 0.001). Of note, 81% of recipients whose BP increased after the transplant had AR. In contrast, 22% of patients whose BP declined post-transplant had AR. Conclusions. Elevated BP levels post-transplant identify patients at high risk of AR independently of graft function. Treatment of BP and reduction of BP levels appears to be associated with a decreased risk of AR. We hypothesize that high BP may be an indicator of a particular type of allograft damage, perhaps ischemic, that may predispose to AR.

AB - Background. Acute rejection (AR) is a strong predictor of renal allograft survival. Recent advances in immunosuppression have reduced considerably the incidence of AR. Still, approximately 25% of patients have AR early post-transplant, and the factors that predispose to AR have not been fully clarified. Methods. The study includes 1641 adults, recipients of first cadaveric (CAD, N = 1195) or living related renal grafts (LRD, N = 446), transplanted in one institution. The variables associated with the occurrence of AR during the first year post-transplant were identified. Results. By univariate analyses, AR was associated with the following variables: younger (P < 0.001); heavier (P = 0.003); and African American recipients (P = 0.002); CAD transplants (P = 0.001); higher number of HLA mismatches (P = 0.001); delayed graft function (DGF, P = 0.001); higher levels of serum creatinine post-transplant (P = 0.003); and higher levels of systolic and/or diastolic blood pressure (BP) post-transplant (P < 0.001). Higher BP levels were also associated with earlier AR episodes (P < 0.0001). By multivariable analysis AR was significantly associated with recipient age, number of HLA mismatches, DGF, pre-PRA and systolic BP. Analysis of BP measured weekly post-transplant indicated that elevated BP levels, even three weeks prior to the AR episode, were significantly associated with AR. For every level of BP, the use of BP medications was associated with a lower incidence of AR (P < 0.0001). Furthermore, the use of calcium channel blockers was also associated with lower incidence of AR (P = 0.001). Of note, 81% of recipients whose BP increased after the transplant had AR. In contrast, 22% of patients whose BP declined post-transplant had AR. Conclusions. Elevated BP levels post-transplant identify patients at high risk of AR independently of graft function. Treatment of BP and reduction of BP levels appears to be associated with a decreased risk of AR. We hypothesize that high BP may be an indicator of a particular type of allograft damage, perhaps ischemic, that may predispose to AR.

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