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Pulse Pressure and Outcome in Kidney Transplantation

Results From the Collaborative Transplant Study

Krüger, Bernd, MD1; Döhler, Bernd, PhD2; Opelz, Gerhard, MD2; Krämer, Bernhard K., MD1; Süsal, Caner, MD2 for the Collaborative Transplant Study

doi: 10.1097/TP.0000000000002440
Original Clinical Science—General

Background. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) are important predictors of graft and patient survival in renal transplantation. Pulse pressure (PP), the difference between systolic and diastolic pressure, has been associated with cardiovascular and renal morbidity in nontransplant epidemiological studies and clinical trials.

Methods. In this large retrospective analysis of prospectively collected data, transplant recipients from 1995 to 2015 were examined for patient and death-censored graft survival.

Results. In 43 006 recipients, a higher 1-year PP was significantly associated with inferior 10-year patient and death-censored graft survival. In patients 60 years or older, SBP but not DBP was associated with 10-year survival, an effect that was pronounced in patients with a normal SBP of <140 mm Hg and an increased PP of 60 mm Hg or greater, highlighting the superior impact of PP on survival in elderly recipients. In recipients 60 years or older, higher PP was associated with increased mortality due to circulatory system diseases but not to infection or cancer. The combination of PP 60 mm Hg or greater and high SBP of 140 mm Hg or greater showed the strongest association with death-censored graft survival across all age groups.

Conclusions. We found convincing evidence that PP 1-year posttransplant is predictive of patient survival, especially in elderly recipients with normal SBP. Combined analysis of SBP and PP showed that high PP confers additional predictive information for patient survival beyond that derived from analysis of SBP alone. With regard to prediction of death-censored graft survival, the combination of high SBP and high PP showed the best correlation across all age groups.

1 Department of Medicine V, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.

2 Institute of Immunology, Heidelberg University, Heidelberg, Germany.

Received 22 March 2018. Revision received 23 July 2018.

Accepted 25 July 2018.

The authors declare no funding or conflicts of interest.

B.K.K., B.K, G.O. and C.S. planned the study, analyzed the results, and wrote the article. B.D. participated in planning and undertook the statistical analysis. B.K.K. and C.S. contributed substantially to critical discussion.

Correspondence: Bernd Krüger, MD, V. Medizinische Klinik, Universitätsklinikum Mannheim Medizinische Fakultät Mannheim der Universität Heidelberg, Theodor-Kutzer-Ufer 1–3, 68167 Mannheim, Germany. (

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