PRETRANSPLANT HYPERTENSION - A MAJOR RISK FACTOR FOR CHRONIC PROGRESSIVE RENAL-ALLOGRAFT DYSFUNCTION

Despite of advances in 1-year survival rates of renal allografts, no c omparable achievements have been made in long-term graft survival. To identify risk factors for chronic progressive renal allograft dysfunct ion we conducted a retrospective study in 639 patients transplanted be tween 1983 and 1990. Graft function was assessed by the slope of indiv idual 1/creatinine regression lines and chronic progressive graft dysf unction was defined as a slope of the 1/creatinine line of >0.1 dl/mg/ year, indicating a loss of glomerular filtration rate of >10 ml/min/ye ar regardless of the initial serum creatinine value. A number of possi ble risk factors were determined and analysed by linear regression ana lysis. One hundred and six patients (16.6%) showed chronic progressive graft dysfunction. No correlation was found between the rate of funct ional deterioration and the age and gender of the donor or the recipie nt, the blood group, the prevalence of hepatitis B or C, the number of blood transfusions, the total ischaemia time, or the number of kidney s from female donors grafted into male recipients. Chronic progressive graft dysfunction was associated with the number of HLA-B/DR mismatch es (P=0.04) and with a first acute rejection episode later than 60 day s after transplantation (P<0.001). Chronic progressive graft dysfuncti on also occurred in the absence of an acute rejection episode. Signifi cantly (P<0.001) more patients with chronic progressive graft dysfunct ion were hypertensive not only 12 months after transplantation, but al so at the time of transplantation, indicating that hypertension may no t only be secondary to deteriorating graft function, but that hyperten sion per se leads to graft damage and initiates chronic progressive gr aft dysfunction. All efforts should be made to control, blood pressure adequately to improve long-term survival of renal allografts.