title: Antihypertensive medication and renal allograft failure: a North American Pediatric Renal Transplant Cooperative Study report.
abstract: Hypertension after renal transplantation occurs commonly and, in adults, is associated with decreased graft survival. The North American Pediatric Renal Transplant Cooperative Study database was analyzed to determine: (1) the percent use of antihypertensive (anti-HTN) medication based on donor type, race, age, and acute rejection status; and (2) whether use of anti-HTN medication is associated with higher rates of subsequent graft failure. Data regarding anti-HTN medication use was available in 5251 renal allografts (4821 patients) with >30 d graft function. Posttransplant follow-up data were collected at 30 d, 6 mo, 12 mo, and then annually for 5 yr. At each follow-up, patients were selected for further analysis if the graft was functioning at that visit and subsequent follow-up data were available. Overall, anti-HTN medication use was 79% on day 30 and 58% at 5 yr. At each follow-up, anti-HTN medication use was higher (P < 0.01) for cadaveric donor versus living related donor, blacks versus whites, age >12 versus <12 yr, and > or = 1 versus 0 acute rejection episodes. Anti-HTN medication use at each annual follow-up was associated with significantly higher rates of subsequent graft failure. Multiple regression analysis controlling for all factors associated with increased use of anti-HTN medications revealed a relative risk of graft failure for use of anti-HTN medication of greater than 1.4 (P < 0.001). In recipients of cadaveric allografts, only acute rejection status predicted subsequent graft failure more strongly than use of anti-HTN medications. These data suggest that hypertension after renal transplantation in children, as evidenced by use of anti-HTN medications, is associated with increased rates of subsequent graft failure.
authors.affiliation: Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA. jsorof@texaschildrenshospital.org
authors.forename: J M
authors.initials: JM
authors.lastname: Sorof
authors.forename: E K
authors.initials: EK
authors.lastname: Sullivan
authors.forename: A
authors.initials: A
authors.lastname: Tejani
authors.forename: R J
authors.initials: RJ
authors.lastname: Portman
mesh_terms: D017677:Age Distribution; D000959:Antihypertensive Agents / Q000009:adverse effects* / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000209:etiology; D007223:Infant; D007231:Infant, Newborn; D007676:Kidney Failure, Chronic / Q000601:surgery*; D016030:Kidney Transplantation / Q000009:adverse effects / Q000379:methods / Q000401:mortality / Q000706:statistics & numerical data*; D008297:Male; D015995:Prevalence; D016016:Proportional Hazards Models; D012042:Registries; D012044:Regression Analysis; D012307:Risk Factors; D014184:Transplantation, Homologous / Q000009:adverse effects; D014481:United States / Q000453:epidemiology
chemical_list: D000959:Antihypertensive Agents