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Nikolaos Pagonas, Samad Kor, Felix Sebastian Seibert, Arnd Giese, Walter Zidek, Petra Reinke, Nina Babel, Frederic Bauer, Timm Westhoff

• \(\textbf{Background:}\) Hyperuricemia is very common after renal transplantation. It is associated with an increased risk of cardiovascular events and graft loss. To date, however, treatment is only recommended in symptomatic disease. \(\textbf{Material/Methods:}\) We included 503 adult patients who underwent kidney transplantation at the Charité-Universitätsmedizin Berlin in this retrospective study. Patients were followed up for up to 120 months. All-cause mortality, graft survival, changes in level of serum uric acid (SUA), and estimated glomerular filtration rate (eGFR) were analyzed. \(\textbf{Results:}\) At 12 months post-transplantation, 225 patients had a serum uric acid (SUA) level >7 mg/dl: 52 patients were treated with allopurinol, 37 with benzbromarone, and 136 patients received no medication for hyperuricemia (control). At 12 months, eGFR did not differ between groups (p=0.15) but treated patients had higher SUA levels (p<0.001) compared to the control group. SUA-lowering treatment was associated with a lower risk of allcause mortality (p=0.013) and graft loss (p=0.014) compared to controls. At 120 months, patients in the treatment group had lower SUA levels (p=0.001) and higher eGFR (p<0.001) compared to the control group. \(\textbf{Conclusions:}\) Treatment of asymptomatic hyperuricemia was associated with a substantial benefit in patient and graft survival.