The disparity between donor kidney availability and demand has increased utilization of kidneys from marginal living donors, including hypertensive donors. The aim of this study was to compare kidney graft outcomes of patients after transplantation with kidneys from hypertensive and normotensive living donors.

Data was prospectively collected on consecutive recipients who underwent kidney transplantation from live donors in 2002-2012. We collected data regarding kidney function, graft and patient survival and demographics from donors and recipients. Donors were categorized as hypertensive or normotensive, elderly (≥60 years) or younger (<60 years) and with high Body Mass Index (BMI) (≥ 30) or normal BMI (<30).

A total of 494 patients (300 males, 194 females) who received a kidney from a living donor were included in the study. 45 donors had pre-transplantation hypertension. During the follow up of 73 months (median, range 2-145), 77 patients lost their grafts and 41 patients died. There was no difference regarding gender among patients with and without graft loss (p=0.086). Patients who lost their grafts were more likely to have a hypertensive donor (p=0.003) or a donor of Afro-Caribbean ethnicity (p=0.022). There was no association of elderly donors (p=0.305) or donors with high BMI (p=0.348) with the risk of graft loss. The median eGFR for recipients of kidneys from normotensive donors was 53 ml/min (range 14-93) at 3 years and 48 ml/min at 5 years (range 17-73), whereas for recipients who received kidneys from hypertensive donors median eGFR was 46 ml/min (range 15-90) and 53 ml/min (range 27-90), respectively (p=0.103 and p=0.381 respectively). In survival analysis, recipients of kidneys from hypertensive donors had reduced graft survival (log rank p<0.001) and reduced patient survival (log rank p=0.042), but the latter was not significant in multivariate analysis (p=0.212). In Cox-regression analysis, Afro-Caribbean ethnicity (Hazard Ratio (HR) 2.199, 95% Confidence Intervals (CI) 1.194-4.051, p=0.009), rejection (HR 5.212, 95% CI 3.186-8.524, p<0.001) and donor hypertension (HR 2.140, 95% CI 1.159-3.953, p=0.015 increased the risk of graft failure.

Receiving a kidney from a donor with history of hypertension was associated with increased risk of graft loss. Although the group of hypertensive donors was relatively small, this group of donors seems to merit additional study and focus.

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