Abstract Type : Oral presentation
Abstract Submission No.: A-0223
Abstract Topic : Transplantation
Post-Donation Systolic Blood Pressure Trajectories After Living Kidney Donation and Paired Recipient Outcomes: A Nationwide Prospective Cohort Study from KOTRY
Jeong-Yeun Lee1, Hye Eun Yoon2, Soo Jin Na Choi3, Sung Shin4, Seungyeup Han5, Jaeseok Yang6, Myoung Soo Kim7, Yu Ho Lee1, Hyeon Seok Hwang1
1Department of Internal Medicine-Nephrology, Kyung Hee University Medical Center, Korea, Republic of
2Department of Internal Medicine-Nephrology, The Catholic University of Korea Seoul St. Mary's Hospital , Korea, Republic of
3Department of Surgery, Chonnam National University Hospital, Korea, Republic of
4Department of Surgery, Asan Medical Center, Korea, Republic of
5Department of Internal Medicine-Nephrology, Keimyung University Dongsan Medical Center, Korea, Republic of
6Department of Internal Medicine-Nephrology, Severance Hospital, Korea, Republic of
7Department of Surgery, Severance Hospital, Korea, Republic of
Methods : A total of 3,844 living donor–recipient pairs were enrolled from a nationwide multicenter prospective cohort. Longitudinal systolic blood pressure (SBP) measurements of donors after donation were analyzed using latent class mixture modeling to identify SBP trajectories. Donor outcomes and paired recipient outcomes, including incident and uncontrolled hypertension, change in estimated glomerular filtration rate (eGFR), and graft loss were compared.
Results : We identified two donor SBP trajectory classes: Class 1 (95.1%), gradual increase; Class 2 (4.9%), steeper increase from a higher baseline. Class 2 donors had significantly higher cumulative incidence of new-onset hypertension and diabetes, and eGFR <60 mL/min/1.73 m² (all p<0.001). Among recipients without pre-transplant hypertension, those of class 2 donors had a higher risk of incident hypertension compared to recipients of class 1 donors (adjusted hazard ratio 2.47; 95% confidence interval 1.31–4.66). In recipients with pre-existing hypertension, donor SBP trajectory was not associated with uncontrolled hypertension; however, recipients of class 2 donors showed a greater decline in eGFR (adjusted β = −0.68; 95% confidence interval −1.08 to −0.27). Graft loss rate did not differ between recipients of two donor SBP trajectories.
Conclusions : Distinct post-donation SBP trajectories of living donors were associated with adverse donor outcomes, incident hypertension in KTRs without pretransplant hypertension, and greater eGFR decline in KTRs with pretransplant hypertension. These findings support the clinical importance of longitudinal donor blood pressure monitoring.