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Factors associated with cardiovascular target organ damage in children after renal transplantation
Bianca Borchert-Mörlins1, Daniela Thurn1, Bernhard M W Schmidt2
1Department of Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Germany.
Insights
Children after renal transplantation (RT) show significant cardiovascular damage, including arterial and cardiac changes. Key risk factors include hypertension, obesity, and immunosuppression, highlighting the need for focused management of blood pressure and weight post-transplant.
Area of Science:
- Pediatric Nephrology
- Cardiovascular Research
- Transplantation Medicine
Background:
- Cardiovascular disease is a leading cause of mortality in pediatric renal transplant recipients.
- Subclinical cardiovascular damage, including arterial and cardiac lesions, is a concern in this population.
- Identifying risk factors is crucial for improving long-term outcomes.
Purpose of the Study:
- To evaluate subclinical cardiovascular target organ damage in children post-renal transplantation (RT).
- To identify contributing risk factors for cardiovascular damage in this cohort.
- To analyze arterio- and atherosclerotic lesions and cardiac remodeling.
Main Methods:
- 109 children (mean age 13.1 years) who underwent RT were assessed.
- Evaluated anthropometric data, laboratory values, and ambulatory blood pressure monitoring (ABPM).
- Measured aortic pulse wave velocity (PWV), carotid intima-media thickness (IMT), and left ventricular mass (LVM) non-invasively.
Main Results:
- Elevated PWV (22%) and IMT (58%) were observed.
- Left ventricular hypertrophy was present in 43% of patients.
- Hypertension prevalence was 41%, with 16% detected solely by ABPM. Higher diastolic blood pressure, everolimus, and lower eGFR were linked to high PWV; higher systolic blood pressure and BMI were linked to elevated LVM.
Conclusions:
- Children after RT exhibit a high prevalence of subclinical cardiovascular organ damage.
- Hypertension, obesity, immunosuppression, and renal function are independent risk factors.
- Management strategies should prioritize blood pressure and weight control in pediatric RT recipients.
Background:
Cardiovascular disease is the second-most common cause of death in pediatric renal transplant recipients. The aim of this study was to evaluate subclinical cardiovascular target organ damage defined as the presence of arterio- and atherosclerotic lesions and cardiac remodeling and to analyze contributing risk factors in a large cohort of children after renal transplantation (RT).
Methods:
A total of 109 children aged 13.1 ± 3.3 years who had undergone RT at one of three German transplant centers were enrolled in this study. Patients had been transplanted a mean of 5.5 (±4.0) years prior to being enrolled in the study. Anthropometric data, laboratory values and office- and 24-h ambulatory blood pressure monitoring (ABPM) were evaluated. Cardiovascular target organ damage was determined through non-invasive measurements of aortic pulse wave velocity (PWV), carotid intima-media thickness (IMT) and left ventricular mass (LVM).
Results:
Elevated PWV or IMT values were detected in 22 and 58% of patients, respectively. Left ventricular hypertrophy was found in as many as 43% of patients. The prevalence of uncontrolled or untreated hypertension was 41%, of which 16% of cases were only detected by ABPM measurements. In the multivariable analysis, higher diastolic blood pressure, everolimus intake and lower estimated glomerular filtration rate were independently associated with high PWV. Higher systolic blood pressure and body mass index were associated with elevated LVM.
Conclusions:
Our results showed an alarming burden of cardiovascular subclinical organ damage in children after RT. Hypertension, obesity, immunosuppressive regimen and renal function emerged as independent risk factors of organ damage. Whereas the latter is not modifiable, the results of our study strongly indicate that the management of children after RT should focus on the control of blood pressure and weight.
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