Abstract 4368019: High Visit-to-Visit Systolic Blood Pressure Variability Predicts Adverse Outcomes in Kidney Transplant Recipients: A Nationwide Cohort Study

Background&Objective: Visit-to-visit blood pressure variability (VVBPV) has emerged as an independent predictor of cardiovascular and renal outcomes, but its prognostic significance in kidney transplant recipients—especially in Asian populations—remains unclear. We aimed to assess whether elevated VVBPV predicts adverse long-term outcomes in Korean kidney transplant recipients, using a nationwide cohort to provide real-world evidence in this underrepresented population. Methods: We analyzed 5,532 adult recipients from the Korea Organ Transplantation Registry (2014–2022). VVBPV was calculated as the average real variability (ARV), standard deviation (SD), and coefficient of variation (CV) of systolic blood pressure (SBP) measured during routine post-transplant follow-up. Patients were stratified into tertiles based on ARV. The primary composite outcome included graft loss, new-onset cardiovascular disease (CVD), or ≥50% decline in estimated glomerular filtration rate (eGFR). Cox proportional hazards models were adjusted for age, sex, BMI, comorbidities, and 6-month post-transplant clinical variables. Results: During a median follow-up of 55.4 months, 541 patients (9.8%) experienced the primary outcome. Graft loss occurred in 200 patients (3.6%), incident CVD in 176 (3.2%), and ≥50% eGFR decline in 337 (6.1%). Compared with Group 1 (lowest ARV), Group 3 (highest ARV) had a significantly increased risk of the composite outcome (HR 1.755; 95% CI 1.401–2.198; p<0.001). SD and CV showed consistent results (SD: HR 1.483; 95% CI 1.194–1.841; CV: HR 1.558; 95% CI 1.256–1.932; all p<0.001). Group 3 also had elevated risk for secondary outcomes including graft loss (HR 1.716; 95% CI 1.242–2.372; p<0.001), dialysis dependence (HR 1.822; 95% CI 1.312–2.526; p<0.001), and >30% eGFR decline (HR 1.641; 95% CI 1.306–2.062; p<0.001). Subgroup analyses revealed more pronounced associations in patients with diabetes (HR 2.13) and those with pre-existing CVD (HR 1.96), although interaction p-values were not statistically significant. Kaplan-Meier analysis showed reduced event-free survival in higher VVBPV groups (log-rank p<0.001). Conclusion: VVBPV may be a clinically relevant prognostic indicator in kidney transplant recipients. Prospective studies are needed to validate these associations and explore potential interventions. These findings suggest that VVBPV may also serve as a useful risk stratification marker in long-term transplant care.