Antihypertensive pharmacotherapy and long-term outcomes in pediatric kidney transplantation

Area of Science:

• Nephrology
• Pediatric Nephrology
• Transplantation Immunology

Background:

• Hypertension (HTN) is a frequent complication in pediatric kidney transplant (KT) recipients.
• Long-term outcomes for pediatric KT recipients with HTN require further investigation.

Purpose of the Study:

• To assess the impact of HTN on long-term graft survival (>10 years) in pediatric KT recipients.
• To evaluate the role of antihypertensive medication, specifically angiotensin-converting enzyme inhibitors (ACEIs), in pediatric KT recipients with HTN.

Main Methods:

• Retrospective study of 293 pediatric KT recipients with graft survival (GS) ≥5 years.
• HTN defined by antihypertensive medication use at 5 years post-KT.
• Comparison of long-term actuarial GS and patient survival between recipients with and without HTN.

Main Results:

• 55% of recipients did not have HTN at 5 years post-KT; 45% had HTN.
• Actuarial GS at 15 and 20 years was significantly poorer in recipients with HTN (53% and 33%) compared to those without (68% and 53%, p=0.006).
• Among living donor recipients with HTN treated with one antihypertensive, 15-year GS was 100% with ACEI therapy versus 44% without (p=0.04).

Conclusions:

• HTN at 5 years post-pediatric KT is associated with diminished long-term graft survival.
• ACEI therapy for HTN in pediatric KT recipients may be associated with improved graft survival.
• Further studies are warranted to confirm the benefit of ACEI therapy in this population.