title: Antihypertensive pharmacotherapy and long-term outcomes in pediatric kidney transplantation.
abstract: Hypertension (HTN) is common in pediatric recipients following kidney transplantation (KT). We retrospectively assessed the impact of HTN on long-term (>10-yr) outcomes in pediatric KT recipients (aged < 18 yr) at our center. Two hundred and ninety-three pediatric KT recipients (83% living donor [LD]) with graft survival (GS) for ≥5 yr were studied. HTN was defined by antihypertensive medication use at five yr post-KT. One hundred and sixty (55%) recipients did not have HTN, and 133 (45%) had HTN at five yr post-KT. There were no differences in actuarial patient survival between cohorts. Actuarial GS at 15 and 20 yr was 68% and 53% for recipients without HTN, and 53% and 33% for recipients with HTN (p = 0.006). Among LD recipients using one antihypertensive, GS at 15 yr was 100% for those using an angiotensin-converting enzyme inhibitor (ACEI) and 44% for those not using an ACEI (p = 0.04). Among these recipients, HTN treated with no ACEI was a significant risk factor for graft failure at >5 yr (hazard ratio [HR] = 2.5, p = 0.02), but HTN treated with an ACEI was not (HR = 0.6, p = 0.7). HTN at five yr post-KT is associated with poorer long-term GS in pediatric recipients, but ACEI therapy may enable better outcomes and should be studied further.
authors: Division of Transplantation, Department of Surgery, University of Minnesota, Minneapolis, MN 55454, USA.
authors: Thomas M
authors: TM
authors: Suszynski
authors: Michael D
authors: MD
authors: Rizzari
authors: Kristen J
authors: KJ
authors: Gillingham
authors: Michelle N
authors: MN
authors: Rheault
authors: Wojciech
authors: W
authors: Kraszkiewicz
authors: Arthur J
authors: AJ
authors: Matas
authors: Blanche M
authors: BM
authors: Chavers
mesh_terms: D000293:Adolescent; D000959:Antihypertensive Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000188:drug therapy / Q000209:etiology / Q000401:mortality*; D006085:Graft Survival; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000209:etiology / Q000401:mortality*; D007674:Kidney Diseases / Q000150:complications* / Q000401:mortality / Q000601:surgery; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000401:mortality; D008297:Male; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors
chemical_list: D000959:Antihypertensive Agents
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