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Hypertension following renal transplantation in children
M Broyer1, G Guest, M F Gagnadoux
1Hôpital des Enfants Malades, Paris, France.
Insights
Hypertension (HT) is a common complication after kidney transplantation in children. Chronic graft rejection and renal artery stenosis (RAS) are major causes, leading to severe outcomes.
Area of Science:
- Pediatric Nephrology
- Transplantation Medicine
- Cardiovascular Health in Children
Background:
- Hypertension (HT) is a significant concern following pediatric kidney transplantation.
- Understanding the incidence and causes of HT is crucial for improving patient outcomes.
Purpose of the Study:
- To review the incidence and causes of hypertension after kidney transplantation in children and adolescents.
- To analyze the complications associated with post-transplant hypertension.
Main Methods:
- Retrospective review of 334 cadaver kidney (CK) and 27 living related (LR) transplantations.
- Analysis of patient data from 1973 to 1984, focusing on hypertension development and causes.
Main Results:
- 62% of CK recipients developed long-term hypertension; chronic graft rejection was a primary cause.
- Renal artery stenosis (RAS) occurred in 13% of CK recipients, with limited success from interventions.
- Hypertension was less frequent but still present in LR transplant recipients.
Conclusions:
- Hypertension is a frequent and potentially severe complication after pediatric kidney transplantation.
- Chronic graft rejection and RAS are key contributors to post-transplant hypertension.
- Effective management strategies for hypertension are essential in pediatric transplant care.
Abstract:
The files of 334 consecutive cadaver kidney (CK) and of 27 living related (LR) transplantations (T) in children and adolescents performed from 1973 to 1984 have been reviewed. Following cadaver transplantation, 52 patients (15%) never had hypertension (HT), 41 patients (12%) had only initial HT up to 6 months after transplantation and 18 other patients (5%) exhibited transient HT episodes while on high-dose steroid therapy. Finally, 209 patients (62%) had HT for periods longer than 6 months and 16 patients (5%) until death or graft failure within the first 3 months. Chronic graft rejection was the major cause of HT, but other factors either isolated or in association were also present. Renal artery stenosis (RAS) was diagnosed in 43 cases (13%) 2-17 months post-transplantation; 10 of these were operated upon (5 successfully) and 9 underwent transluminal angioplasty with a single success. Nine cases of RAS resolved spontaneously. HT was attributed to the host kidney in 10 cases (3%) and to recurrence of primary renal disease in 9 (3%). HT observed after CKT was sometimes severe and difficult to control. Acute complications from HT were recorded in 35 cases, with 6 deaths and 2 severe neurological sequelae. Among 25 LRT, 11 cases (40%) had no HT 13 (48%) had HT for longer than 6 months. In this group, no case of RAS was observed and only one complication (without sequelae) was noted. In conclusion, HT is a frequent and sometimes severe complication post-transplantation in children and adolescents.