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Use of anti-hypertensive medications and post-transplant renal allograft function in children
J M Sorof1, S L Goldstein, E D Brewer
1Department of Pediatrics, Baylor University School of Medicine, Houston, Texas, USA.
Insights
Children needing anti-hypertensive medications after kidney transplants show worse allograft function. This highlights the association between post-transplant hypertension and reduced kidney function in pediatric recipients.
Area of Science:
- Pediatric Nephrology
- Transplant Medicine
- Hypertension Research
Background:
- Post-transplant hypertension is frequent in pediatric kidney transplant recipients.
- The impact of hypertension on renal allograft function in children remains unclear.
Purpose of the Study:
- To investigate the association between anti-hypertensive medication use and renal allograft dysfunction in pediatric kidney transplant patients.
- To analyze the relationship between hypertension management and graft function over time post-transplant.
Main Methods:
- Retrospective analysis of monthly clinical data from pediatric renal transplant recipients for up to three years.
- Calculation of estimated glomerular filtration rate (eGFR) using the Schwartz formula.
- Comparison of eGFR and cyclosporin A (CsA) trough levels between patients with and without anti-hypertensive medications.
Main Results:
- Patients requiring anti-hypertensive medications had significantly lower eGFR at all post-transplant intervals compared to those not on medication (p < 0.01).
- Higher mean CsA trough levels were observed in patients receiving anti-hypertensive medications.
- Lower eGFR was associated with anti-hypertensive use, though this varied by donor type and rejection history.
Conclusions:
- The need for anti-hypertensive medications in pediatric kidney transplant recipients is linked to poorer allograft function.
- While causality cannot be definitively established, anti-hypertensive medication use serves as an indicator of impaired graft function.
Abstract:
Post-transplant hypertension is a common occurrence in children. The relative effect of this hypertension on renal allograft function is uncertain. Examining the accumulated data for pediatric renal transplant recipients at our institution from monthly visits for up to three years, we determined whether the use of anti-hypertensive medications (anti-HTN medications) was associated with allograft dysfunction. Monthly clinical data included height, weight, serum creatinine, cyclosporin A (CsA) trough levels, number of acute rejection episodes, and number of anti-HTN medications. Estimated glomerular filtration rate (eGFR) was calculated monthly for each patient using the Schwartz formula. Time post-transplant was grouped into 6-month intervals. One thousand three hundred and sixty-three monthly data sets from 6 months (n = 76 patients) to 3 yr post-transplant (n = 47 patients) were analyzed. Overall mean eGFR was 75 mL/min/1.73 m2 at 6 months and 54 mL/min/1.73 m2 at 3 yr. A lower eGFR was found at all post-transplant time intervals for patients receiving anti-HTN medications compared with those who were not (p < 0.01). This lower eGFR was found at some but not all times post-transplant when patients were grouped by donor type or history of acute rejection episodes and analyzed separately. Mean CsA trough levels were higher at all post-transplant time intervals in patients receiving anti-HTN medications (p < 0.05). While a causal relationship between post-transplant hypertension and graft dysfunction cannot be established from this study, we conclude that the need for anti-HTN medications is associated with worse allograft function.