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-year) outcomes in pediatric (aged <18 years) recipients at our center. 293 pediatric KT recipients (83% living donor [LD]) with graft survival (GS) for ≥5 years were studied. HTN was defined by antihypertensive medication use at 5 years post-KT. 160 (55%) recipients did not have HTN and 133 (45%) had HTN at 5 years post-KT. There were no differences in actuarial patient survival between cohorts. Actuarial GS at 15 and 20 years was 68% and 53% for recipients without HTN, and 53% and 33% for recipients with HTN (p=0.006). Among LD recipients using 1 antihypertensive, GS at 15 years 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 years (hazard ratio [HR] = 2.5, p=0.02), but HTN treated with an ACEI was not (HR=0.6, p=0.7). HTN at 5 years post-KT is associated with poorer long-term GS in pediatric recipients, but ACEI therapy may enable better outcomes and should be studied further.

Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents

“…543 Children in these studies who achieved normotension had stable graft function, whereas those who remained hypertensive at 2 years had a progression of renal disease. 544 Antihypertensive medications have rarely been systematically studied in this population. There is limited evidence that ACE inhibitors and ARBs may be superior to other agents in achieving BP control and improving long-term graft survival in renaltransplant patients.…”

Incidence and magnitude of post‐transplant cardiovascular disease after pediatric kidney transplantation: Risk factor analysis of 1058 pediatric kidney transplants at the university of Minnesota

“…Our immunosuppressive protocol for pediatric KT recipients has been described previously . The evolution of induction therapy at the University of Minnesota is depicted in Figure A.…”

“…Our immunosuppressive protocol for pediatric KT recipients has been described previously. [6][7][8][9][10] The evolution of induction therapy at the University of Minnesota is depicted in Figure 1A. All recipients were treated with antibody induction: between 1963 and 1993, induction was Minnesota ALG; between 1992 and 1999, ATGAM; and since 1999, Thymo.…”

Long‐term outcomes of pediatric kidney transplant recipients with a pretransplant malignancy

“…Our immunosuppressive protocols have been described previously . In brief, for the majority of the time period studied, each KT recipient received quadruple therapy, which included a combination of: (a) an induction antibody (ALG, ATGAM, or thymoglobulin); (b) prednisone (maintenance or RDP); (c) AZA or MMF, and (d) CsA or Tac.…”

“…Our immunosuppressive protocols have been described previously. [12][13][14][15][16][17] In brief, for the majority of the time period studied, each…”