Antihypertensive pharmacotherapy and long-term outcomes in pediatric kidney transplantation

Thomas M. Suszynski, Michael D. Rizzari, Kristen J. Gillingham, Michelle N. Rheault, Wojciech Kraszkiewicz, Arthur J. Matas, Blanche M. Chavers

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16 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)472-480
Number of pages9
JournalClinical Transplantation
Volume27
Issue number3
DOIs
StatePublished - May 2013

Keywords

  • Angiotensin blockade
  • Hypertension
  • Kidney transplantation
  • Pediatrics

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