*Purpose: Allografts from living kidney donors may “carry” subclinical pathological abnormalities to the recipient and thus lead to adverse clinical outcomes. Because one mechanism underlying hypertension is a diminished number of nephrons, allografts from donors with hypertension may provide the recipient with insufficient number of nephrons with maladaptive consequences associated with hyperfiltration injury. We sought to understand change in eGFR over time and survival in recipients of allografts from donors with- vs. without hypertension, stratified by donor age.

*Methods: Using a national cohort of adult living-donor kidney transplantation recipients 1/1/2005-6/30/2017, we studied 49,990 recipients from younger (<50 years old) donors including 597 whose donors had hypertension and 21,130 recipients from older (≥50 years old) donors including 1441 whose donors had hypertension. We used mixed models with random intercepts and random slopes and Cox regression models adjusting for recipient, donor, and transplant characteristics.

*Results: Median follow-up was 5.4 years (IQR 2.9-8.5, maximum, 13.2). Among recipients from younger donors with- vs. without hypertension, the annual eGFR decline was -1.10 vs. -0.50 mL/min/m² (p<0.01); 12-year all-cause graft survival was 50.3% vs. 56.0% (graft failure hazard ratio [HR] 1.21; 95% CI 1.03-1.43; p=0.02). Among recipients from older donors with- vs. without hypertension, the annual eGFR decline was -0.68 vs. -0.64 mL/min/m² (p=0.7); 12-year all-cause graft survival was 50.7% vs. 50.0% (graft failure HR 1.04; 95% CI 0.93-1.17; p=0.5).

*Conclusions: Hypertension in younger, but not in older, donors was associated with worse recipient outcomes.

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