Survival rates after liver transplantation using hypertensive donor grafts: an analysis of the Scientific Registry of Transplant Recipients database

Background The use of grafts from donors with hypertension (HTN) in liver transplantation has grown rapidly recently, but whether HTN donors affect post-liver transplantation survival is unclear. Methods We used data from the Scientific Registry of Transplant Recipients database (2004-2008), and evaluated differences in baseline characteristics and outcomes between recipients of grafts from HTN and non-HTN donors. Kaplan-Meier and multivariate Cox regression models were used in assessing patient survival. Results We identified 8,411 recipients of HTN donor grafts (33.2%) and 16,891 (66.8%) recipients of non-HTN donor grafts. Graft and patient survival rates were significantly lower in recipients of HTN donor grafts versus non-HTN donor grafts (1-year, 3-year, and 5-year graft survival rates of 75%, 64%, 50% vs. 80%, 72%, 62% [P < 0.001], respectively, and patient survival rates of 79%, 69%, 56% vs. 83%, 75%, 65% [P < 0.001], respectively). A history of HTN > 5 years was also associated with lower rates of graft and patient survival (P < 0.001). A HTN donor was independently associated with a higher risk of graft loss (hazard ratio 1.10, 95% confidence interval 1.01-1.18). Conclusion The present study shows that graft and patient survivals were lower in recipients of hypertensive donor grafts, and highlights the importance of appropriately screening donors for HTN.