Impact of pre-existing donor hypertension and diabetes mellitus on cadaveric renal transplant outcomes

Hypertension (HTN) and diabetes mellitus (DOM) predispose to systemic ather osclerosis with renal involvement. The prevalence of HTN and DM in cadaveri c renal donors (affected donors) and the results of transplantation are unk nown. We investigated these issues with national data from the US Renal Dat a System. A total of 4,035 transplants from affected donors were matched 1: 1 with unaffected controls according to donor age and race, recipient race, and year of transplantation. Graft and patient survival were estimated. Am ong the 25,039 solitary renal transplantations performed between July 1, 19 94, and June 30, 1997, cadaveric renal transplants from donors with HTN acc ounted for 15%, and donors with DM, 2%, Programs with 1-year cadaveric rena l graft survival rates greater than 90% had 50% less affected donors compar ed with programs having 1-year cadaveric renal graft survival rates of 85% or less. Compared with donor-age-matched controls, transplants from affecte d donors were at minimally increased risk for primary nonfunction, delayed graft function, and acute rejection. Three-year graft survival rates were 7 1% in affected donor organs and 75% in controls (P = 0.001). Compared with controls, duration of HTN was an independent risk factor for graft survival (3-year graft survival rates, 75% versus 65%; relative risk = 1.36 for HTN >10 years; P < 0.001). A substantial fraction of cadaveric renal donors ha ve preexisting HTN, Programs transplanting fewer affected donor kidneys had better than average results. Because the negative impact of donor HTN and DM on transplant outcome was of moderate degree except when the duration of donor HTN was greater than 10 years, use of affected donors should not be discouraged, but graft and patient survival analyses should account for the ir presence. (C) 2000 by the National Kidney Foundation, Inc.