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Hypertension after pediatric heart transplantation is primarily associated with immunosuppressive regimen
Susan L Roche1, Jacob Kaufmann, Anne I Dipchand
1Division of Pediatric Cardiology, Hospital for Sick Children Toronto, Ontario, Canada. slucyroche@doctors.or.uk
Insights
Hypertension is common in pediatric heart transplant patients. Immunosuppressive drugs, particularly prednisone and sirolimus, significantly increase the risk of developing high blood pressure after transplantation.
Area of Science:
- Pediatric Cardiology
- Transplantation Medicine
- Pharmacology
Background:
- Hypertension is a frequent complication in children following cardiac transplantation.
- Identifying risk factors is crucial for managing post-transplant health outcomes.
Purpose of the Study:
- To investigate the risk factors associated with hypertension in pediatric cardiac transplant recipients.
- To specifically examine the influence of immunosuppressive therapy on hypertension development.
Main Methods:
- Retrospective analysis of 24-hour ambulatory blood pressure monitoring in 51 children over 1 year post-transplant.
- Comparison of clinical data between hypertensive and normotensive patient groups.
- Utilized multiple regression analysis to identify independent risk factors.
Main Results:
- The incidence of hypertension was 49% in the studied cohort.
- Hypertensive patients received more immunosuppressive agents, had higher tacrolimus levels, and were more likely to be on prednisone or sirolimus.
- A combination of prednisone and sirolimus showed a strong association with hypertension (OR 7.3).
Conclusions:
- Hypertension is a significant and common issue in pediatric cardiac transplant recipients.
- The immunosuppressive regimen is the primary driver of hypertension in this population.
Background:
Hypertension is recognized as prevalent in pediatric cardiac transplant recipients. This study investigated risk factors for this complication and, in particular, the role of immunosuppression.
Methods:
Results of 24-hour ambulatory blood pressure monitoring of children surviving more than 1 year after cardiac transplantation were analyzed retrospectively. Subjects were designated either hypertensive or normotensive by comparison with published normal values. To identify factors associated with hypertension, clinical data contemporaneous with 24-hour ambulatory blood pressure monitoring were collected and compared between the groups.
Results:
In the 51 children studied, the incidence of hypertension was 49%. Hypertensive and normotensive recipients were similar for sex, age at transplantation, time between transplantation and 24-hour ambulatory blood pressure results, and choice of calcineurin inhibitor. In contrast, hypertensive patients were taking significantly more immunosuppressive agents (2.92 vs 2.12 p < 0.01), had higher tacrolimus levels (10 vs 8.1 microg/liter, p = 0.03), and were more likely to be on maintenance prednisone therapy (64% vs 23%, p < 0.01) or regimens including sirolimus (40% vs 12%, p = 0.03). Multiple regression analysis controlling for tacrolimus level showed a combination of prednisone and sirolimus was more strongly associated with hypertension than either agent alone, with an odds ratio of 7.3 (95% confidence interval, 1.5-36.1) vs 4.1 (95% confidence interval, 0.85-26.3).
Conclusions:
Hypertension after pediatric cardiac transplantation is a common problem and primarily associated with immunosuppressive regimen.
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