Introduction: The impact of hypertension (HT) of living donors on later kidney graft function remains insufficiently understood.

Methods: We retrospectively reviewed recipients of living donor (LD) kidney transplant (KTX) at a single tertiary center from January 2003 to December 2021 with a follow-up until December 2022. LD blood pressure (BP) values obtained with office measurement and 24 h ambulatory BP monitoring (ABPM) were the main predictors, while recipient estimated glomerular filtration rate (eGFR) and proportion of kidney fibrosis on biopsies were the outcomes. Multivariate analyses were adjusted for pre-transplant donor characteristics: age, sex, ethnicity, body mass index (BMI) and eGFR.

Results: 212 LD KTX recipients were included, with mean age 51 years. 133 were women (62.7%). 73 (34.4%) LD were hypertensive based on office BP. In a sub-group of 112 LD with ABPM, 64 (57.1%) were hypertensive. Office systolic blood pressure (SBP) was negatively associated with eGFR at 6 months, 1 year, 5 years and 10 years (p < 0.05). Office SBP was positively associated with kidney fibrosis at 1 year (p < 0.05). Those associations were not significant after multivariate adjustment.

Discussion: In conclusion, while an adverse impact of LD HT on later kidney function and fibrosis was measured, this effect seemed negligible after accounting for other more relevant clinical characteristics.