Kim Jong Ho, Lee Yu Ho, Kim Dae Kyu, Kim Jin Sug, Jeong Kyung Hwan, Chung Ku Yong, Jeong Jong Cheol, Choi Soo Jin Na, Yang Jaeseok, Kim Myoung Soo, Hwang Hyeon Seok
Division of Nephrology, Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University College of Medicine, Seoul, Republic of Korea.
Division of Nephrology, Department of International Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea.
Kidney Res Clin Pract. 2025 Jul;44(4):602-611. doi: 10.23876/j.krcp.23.283. Epub 2024 Aug 21.
Living kidney donors with hypertension are potential candidates for solving the donor shortages in renal transplantation. However, the safety of donors with hypertension after nephrectomy has not been sufficiently confirmed.
A total of 642 hypertensive and 4,848 normotensive living kidney donors who were enrolled in the Korean Organ Transplantation Registry between May 2014 and December 2020 were included in this study. The study endpoints were a decreased estimated glomerular filtration rate (eGFR) and proteinuria.
In the entire cohort, donors with hypertension had a lower eGFR before nephrectomy in comparison to normotensive donors which remained lower after kidney transplantation. The incidence of proteinuria in hypertensive donors increased during follow-up. In propensity score-matched analysis, the risk of eGFR being <60 mL/min/1.73 m2 (hazard ratio [HR], 0.77; 95% confidence interval [CI], 0.50-1.19) or <45 mL/min/1.73 m2 (HR, 0.50; 95% CI, 0.06-4.03) was not significantly increased in donors with hypertension. However, hypertensive donors were found to have a significantly higher risk of proteinuria than normotensive donors (HR, 2.28; 95% CI, 1.05-4.94). Similar findings were also observed in the analysis of the entire cohort, indicating that hypertensive donors had a significantly higher risk of proteinuria (adjusted HR, 1.77; 95% CI, 1.10-2.85), without a substantial increase in the risk of decreased renal function.
The risk of proteinuria after donation was substantially increased in donors with hypertension. These findings underscore the need for careful monitoring of proteinuria in hypertensive donors following donation.
患有高血压的活体肾供体是解决肾移植供体短缺问题的潜在候选者。然而，高血压供体肾切除术后的安全性尚未得到充分证实。
本研究纳入了2014年5月至2020年12月期间登记在韩国器官移植登记处的642名高血压活体肾供体和4848名血压正常的活体肾供体。研究终点为估计肾小球滤过率（eGFR）降低和蛋白尿。
在整个队列中，高血压供体在肾切除术前的eGFR低于血压正常的供体，肾移植后仍较低。高血压供体蛋白尿的发生率在随访期间有所增加。在倾向评分匹配分析中，高血压供体的eGFR<60 mL/min/1.73 m²（风险比[HR]，0.77；95%置信区间[CI]，0.50-1.19）或<45 mL/min/1.73 m²（HR，0.50；95% CI，0.06-4.03）的风险没有显著增加。然而，发现高血压供体蛋白尿的风险显著高于血压正常的供体（HR，2.28；95% CI，1.05-4.94）。在整个队列分析中也观察到了类似的结果，表明高血压供体蛋白尿的风险显著更高（调整后HR，1.77；95% CI，1.10-2.85），而肾功能下降的风险没有大幅增加。
高血压供体捐献后蛋白尿的风险大幅增加。这些发现强调了对高血压供体捐献后蛋白尿进行仔细监测的必要性。
