Early posttransplantation hypertension and poor long-term renal allograft survival in pediatric patients.
OBJECTIVE
To evaluate the effect of early hypertension on long-term allograft survival in children with kidney transplantation.


METHODS
Data from a total of 159 patients (mean age, 12.8+/-4.8 years) who underwent kidney transplantation between 1978 and 1998 and whose allograft was functioning for at least 1 year were analyzed retrospectively. Patients were divided according to the presence of hypertension within the first year after transplantation. Primary outcome was time of allograft failure (death, return to dialysis, or retransplantation).


RESULTS
Kaplan-Meier analysis showed that systolic (P<.0001) and diastolic (P=.016) hypertension was associated with overall worse allograft survival. Children with systolic hypertension had a significantly higher graft failure rate regardless of the type of donor, cause of kidney failure, presence or absence of acute rejection, and allograft function at 1 year after transplantation. The multivariate Cox regression model proved that systolic hypertension was a significant and independent risk factor for poor graft survival (hazard ratio [HR], 1.79; P<.0001). Other predictors included allograft function at 1 year after transplantation (HR, 0.97; P<.0001), acquired cause of end-stage kidney disease (HR, 1.96; P=.01) and age <6 years (HR, 2.61; P=.045).


CONCLUSIONS
Early posttransplantation systolic hypertension strongly and independently predicts poor long-term graft survival in pediatric patients.
Mitsnefes
Mark M
MM
Division of Nephrology and Hypertension, Department of Pediatrics, University of Cincinnati College of Medicine and The Children's Hospital Research Foundation, Cincinnati, Ohio 45299-3039, USA. mark.mitsnefes@chmcc.org
Khoury
Philip R
PR
McEnery
Paul T
PT
D000208:Acute Disease; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000175:diagnosis / Q000453:epidemiology*; D006085:Graft Survival / Q000502:physiology*; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D007676:Kidney Failure, Chronic / Q000601:surgery; D016030:Kidney Transplantation; D008297:Male; D015999:Multivariate Analysis; D011183:Postoperative Complications; D015995:Prevalence; D012044:Regression Analysis; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D014019:Tissue Donors