Unmasking a Silent Risk: Impact of Baseline Hypotension on Kidney Allograft Outcomes in Comparison With Normotensive...

Chronic hypotension is uncommon among kidney transplant recipients, and may adversely affect graft outcomes.

Single-center retrospective cohort study including adult recipients who underwent living-donor kidney transplantation, between 2009 and 2024. Of the 1678 recipients screened, 187 met the inclusion criteria. Hypotension was defined as persistent systolic blood pressure (SBP) <100 mm Hg or mean arterial pressure (MAP) <70 mm Hg throughout follow-up; normotensive had SBP ranging from 100 to 130 mm Hg. Early outcomes included primary non-function (PNF), delayed-graft function (DGF), acute rejection, and thrombotic events, whereas late outcomes included graft survival, renal function, proteinuria, and chronic rejection.

A total of 187 recipients were included (57 hypotensive and 130 normotensive). Hypotensive recipients experienced significantly higher rates of early adverse outcomes, including DGF, PNF, graft vein thrombosis, and acute cellular rejection. Late outcomes were also inferior, with higher rates of chronic rejection and graft failure, as well as poorer graft function and increased proteinuria. Kaplan-Meier analysis demonstrated significantly reduced graft survival among hypotensive recipients (P = .001). On multivariable analysis, persistent hypotension independently predicted both rejection and graft failure.

Baseline hypotension is an underrecognized risk factor in kidney transplantation, associated with an increased risk of early and late graft complications.