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Hypertension in Living Kidney Donors Has No Effect on Complement Activation and Fibrosis

Nadine Wagner1, Miriam Angeloni2, Fulvia Ferrazzi1,2

  • 1Department of Nephropathology, Institute of Pathology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitätsklinikum Erlangen, Erlangen, Germany.

Kidney & Blood Pressure Research
|May 9, 2025
PubMed

Insights

Kidney donation from hypertensive donors shows minimal impact on graft complement deposits and fibrosis one year post-transplant. This suggests hypertension may not be a significant exclusion criterion for living kidney donation.

Area of Science:

  • Nephrology
  • Transplantation Immunology
  • Pathology

Background:

  • Historically, hypertension was a contraindication for living kidney donation due to concerns of accelerated kidney failure.
  • Hypertension is known to induce complement deposition and renal fibrosis, potentially impacting graft health.

Purpose of the Study:

  • To evaluate the effect of donor hypertension on complement deposits and renal fibrosis in kidney grafts.
  • To compare graft histology in hypertensive versus normotensive living kidney donors.

Main Methods:

  • Analysis of zero-time and one-year protocol renal biopsies from 238 living donors (52 hypertensive) for complement deposits (C1q, C3c, MASP-2).
  • Assessment of renal fibrosis using Sirius Red staining and gene expression analysis for fibrosis-associated markers.
  • Comparison with biopsies from deceased donors and patients with hypertensive nephropathy.

Main Results:

  • Minimal complement deposits were observed in all living donor biopsies, irrespective of hypertensive status, compared to hypertensive nephropathy.
  • One-year protocol biopsies showed no significant changes in complement deposits, with only a slight, non-significant increase in renal fibrosis in hypertensive donors.
  • Gene expression analysis indicated that living donor biopsies (hypertensive and normotensive) clustered separately from deceased donor biopsies.

Conclusions:

  • Living kidney donation from hypertensive donors has minimal to no discernible effect on renal complement deposits and fibrosis one year post-transplantation.
  • These findings challenge the traditional exclusion of hypertensive individuals as living kidney donors.
Abstract

Keywords:
Complement systemHypertensionKidney transplantationLiving kidney donorRenal fibrosis

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