Pulse Pressure: A More Relevant Risk Factor for Graft Outcomes in Deceased Donor Kidney Transplantation than Living Donor Transplantation

Background: Pulse pressure (PP) is a hemodynamic indicator associated with arterial stiffness. However, its role in kidney transplant remains unclear, especially in the context of living donor kidney transplantation (LDKT) versus deceased donor kidney transplantation (DDKT). This study aims to investigate the impact of PP according to donor type in kidney transplant. Methods: A total of 2,504 kidney transplant patients were analyzed between 2014 and 2022 from the Korea Organ Transplantation Registry database. PP was calculated from systolic and diastolic blood pressure at 1-year post-transplantation. High PP is defined as exceeding 60 mmHg. Patients were stratified into four groups based on PP and donor type: LDKT with normal/high PP, and DDKT with normal/high PP. Primary outcomes were graft loss and mortality over an 8-year period. Results: Among the kidney transplant recipients, only the group with high PP in DDKT represented markedly higher graft loss (HR 2.260, 95% CI 1.183-4.317, p=0.014) and mortality (HR 2.202, 95% CI 1.098-4.417, p=0.026). Conversely, no significant differences in graft loss or mortality were observed among the other groups. Furthermore, high PP with DDKT group maintained consistently lower estimated glomerular filtration rates throughout the 5-year follow-up period. Additionally, the DDKT group exhibited significantly higher PP compared to the LDKT group at 1-year post-transplantation, with a higher prevalence of high PP in DDKT. Conclusion: In DDKT, elevated PP is associated with inferior graft survival and increased mortality rates, whereas LDKT recipients show a lesser susceptibility to the effects of PP. When considering higher prevalence and impact of elevated PP in DDKT, it essentially should be considered a crucial risk factor in DDKT.