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

In this large retrospective study based on prospectively collected data from CTS, adult recipients of first deceased donor kidney grafts transplanted between 1995 and 2014 were examined for patient and death-censored graft survival if the patient had a functioning graft and a known blood pressure reading at year 1.

In 38,433 renal transplant recipients a higher PP at year 1 was significantly associated with inferior 10-year patient and death-censored graft survival. This association was also seen for SBP and DBP with patient and death-censored graft survival in patients aged <60. In patients aged ≥60 SBP but not DBP was associated with 10-year patient and death-censored graft survival. However in this age group the effect of PP was even more pronounced; especially in patients with a normal SBP of <140 mmHg and an increased PP of ≥60 mmHg 10-year patient survival was decreased, highlighting the superior impact of PP on patient survival in elderly recipients. When causes of death were examined, higher PP was associated with increased mortality due to cardiovascular causes but not to infection or cancer in elderly recipients (≥60 years). The combination of PP ≥60 and high SBP ≥140 mmHg showed the strongest association with death censored graft survival across all age groups.

In this study 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.

CITATION INFORMATION: Krüger B, Döhler B, Krämer B, Süsal C. Pulse Pressure After Renal Transplantation – Influence on Outcome: Results from the Collaborative Transplant Study. Am J Transplant. 2017;17 (suppl 3).

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