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Updated: Mar 22, 2026
Digital Home-Monitoring of Patients after Kidney Transplantation: The MACCS Platform
Published on: April 12, 2021
Effect of Immunosuppressive Therapy on Cardiovascular Risk Factor Prevalence in Kidney-Transplanted Children:
J A García-Bello1, E G Romo-Del Río1, E Mendoza-Gómez2
1Department of Pediatric Nephrology, UMAE Hospital General Centro Médico La Raza, Instituto Mexicano del Seguro Social, México City, Mexico.
Insights
Tacrolimus is the best immunosuppressive therapy for kidney-transplanted children, significantly reducing cardiovascular risk factors (CVRF) like anemia and high LDL-cholesterol compared to cyclosporine or sirolimus.
Area of Science:
- Pediatric Nephrology
- Immunosuppression Therapy
- Cardiovascular Health
Background:
- Cardiovascular disease (CVD) is a leading cause of mortality in pediatric kidney transplant recipients.
- The prevalence of cardiovascular risk factors (CVRF) may increase post-transplant.
- The impact of different immunosuppressive therapies on CVRF in children requires further investigation.
Purpose of the Study:
- To evaluate and compare the prevalence of CVRF in pediatric kidney transplant patients.
- To determine the influence of different immunosuppressive regimens on CVRF.
Main Methods:
- An observational, retrospective, comparative study was conducted on 115 pediatric kidney transplant patients.
- Patients received prednisone and mycophenolic acid, combined with cyclosporine, tacrolimus, or sirolimus.
- Demographic, clinical, biochemical, and immunosuppressive data were analyzed using ANOVA, chi-square, and Fisher's tests.
Main Results:
- Tacrolimus treatment was associated with a lower prevalence of anemia and nephrotic proteinuria compared to other agents.
- Cyclosporine use correlated with higher rates of elevated LDL-cholesterol, serum phosphorus, and calcium-phosphorus product.
- Multivariate analysis indicated cyclosporine significantly increased the odds of elevated phosphorus and calcium-phosphorus.
Conclusions:
- Tacrolimus demonstrated a lower prevalence of CVRF in pediatric kidney transplant recipients compared to cyclosporine and sirolimus.
- Tacrolimus emerges as a preferred immunosuppressive strategy for mitigating CVRF in this population.
Background:
Cardiovascular disease (CVD) is the second major cause of death in kidney-transplanted children. Cardiovascular risk factors (CVRF) prevalence after transplant may increase. The effect of immunosuppressive therapy has not been fully studied in children. The objective of the study was to measure and compare CVRF prevalence in kidney-transplanted children, depending of immunosuppressive therapy.
Methods:
The study was an observational, transversal, retrospective, comparative study of pediatric patients transplanted at UMAE Hospital General Centro Medico La Raza. All patients were treated with prednisone and mycophenolic acid and any of cyclosporine, tacrolimus, or sirolimus. Demographic, clinical, and biochemical variables and immunosuppressive therapy were evaluated. We used analysis of variance, χ(2), and Fisher tests with the SPSS 18.0 statistical program.
Results:
One hundred fifteen patients were studied. Sixty-five (56.5%) were male, and median age was 18.5 ± 2.3 years. Seventy-eight (67.2%) were transplanted from a living related donor. Prevalence of anemia and nephrotic proteinuria was significantly less in patients treated with tacrolimus. Those treated with cyclosporine had a significantly greater prevalence of increased LDL-cholesterol, increased serum phosphorus, and increased calcium-phosphorus. Those treated with tacrolimus had lower, not significant, prevalence of hypertension, hyperuricemia, hypoalbuminemia, hypercholesterolemia, hypertriglyceridemia, and low serum HDL-cholesterol than those treated with sirolimus and cyclosporine. In multivariate analysis, patients treated with cyclosporine had significantly more probability of increased phosphorus (OR, 10.65; 95% CI, 2.75-41.16, P = .001) and calcium-phosphorus (OR, 37.94; 95% CI, 3.45-416.17, P = .003) than those treated with tacrolimus.
Conclusions:
Patients treated with tacrolimus had less prevalence of CVRF than those treated with cyclosporine or sirolimus. Tacrolimus is the best immunosuppressive option to diminish CVRF in children after kidney transplantation.
