title: Tacrolimus Predose Concentration Is Associated With Hypertension in Pediatric Liver Transplant Recipients.
abstract: The aim of the study was to analyze the incidence of hypertension in pediatric liver transplantation (LT) recipients using ambulatory blood pressure measurements (ABPM) and to identify factors associated with hypertension. We also investigated whether hypertension or tacrolimus predose concentration (TAC C0) was associated with increased left ventricular (LV) wall thickness.
  
  
  
  On a retrospective longitudinal base, we included 39 pediatric LT recipients. Median time since transplantation was 65 months (range: 11-183). Two consecutive ABPM were analyzed with a median time interval of 13 months. Data from echocardiographic evaluation parallel to the baseline ABPM were analyzed. All patients except 1 were prescribed tacrolimus. The median TAC C0 was 4 ng/mL (range 0.9-11.2). Univariate and multivariate logistic regression models were fitted to identify factors associated with systolic and diastolic hypertension and LV wall thickness.
  
  
  
  Twenty-two of 39 children were hypertensive at baseline and 19 of 32 were hypertensive at follow-up. At baseline 10 (26%) children had masked systolic hypertension. TAC C0 was associated with systolic (P = 0.007, Exp(B) 2.02, 95% CI 1.2-3.3) and diastolic (P = 0.044, Exp(B) 1.48, 95% CI 1.0-2.2) hypertension. LV wall thickness was increased in children after LT compared with healthy population, but it was not associated with hypertension or TAC C0.
  
  
  
  Given the high prevalence of masked hypertension, ABPM should be performed in all pediatric LT recipients. Systolic and diastolic hypertension is associated with TAC C0; therefore, children with a higher target TAC C0 require a more intensive blood pressure surveillance.
authors.affiliation: *Pediatric Nephrology and Rheumatology Department †Pediatric Cardiology Department ‡SafePedrug Consortium, Ghent, Belgium §Pediatric Gastroenterology, Hepatology and Nutrition Department, Ghent University Hospital, Ghent, Belgium.
authors.forename: Agnieszka
authors.initials: A
authors.lastname: Prytula
authors.forename: Kristof
authors.initials: K
authors.lastname: Vandekerckhove
authors.forename: Ann
authors.initials: A
authors.lastname: Raes
authors.forename: Daniel
authors.initials: D
authors.lastname: De Wolf
authors.forename: Jo
authors.initials: J
authors.lastname: Dehoorne
authors.forename: Johan
authors.initials: J
authors.lastname: Vande Walle
authors.forename: Ruth
authors.initials: R
authors.lastname: De Bruyne
mesh_terms: D000293:Adolescent; D018660:Blood Pressure Monitoring, Ambulatory / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D004305:Dose-Response Relationship, Drug; D004452:Echocardiography; D005260:Female; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000139:chemically induced; D007166:Immunosuppressive Agents / Q000008:administration & dosage* / Q000009:adverse effects; D016031:Liver Transplantation / Q000009:adverse effects*; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D059468:Masked Hypertension / Q000139:chemically induced*; D012189:Retrospective Studies; D016559:Tacrolimus / Q000008:administration & dosage* / Q000009:adverse effects
chemical_list: D007166:Immunosuppressive Agents; D016559:Tacrolimus