Abnormal circadian blood pressure regulation in liver transplanted children

Abstract

HT is a frequent cardiovascular risk factor in liver transplant recipients. However, there are only few studies in the literature regarding the risk of HT in liver transplanted children. The aim of this study was to assess the 24 h BP profiles of liver transplanted patients and to compare the results with healthy children. ABPM was performed on 20 liver transplanted patients and 27 healthy children aged 7.1 ± 4.8 and 8.5 ± 2.9 yr, respectively. HT was defined as SDS > 1.64 (i.e., >95th percentile) adjusted for gender and height. The mean duration of post-transplant follow-up was 32 ± 19 months. Six (30%) patients were found to be hypertensive. The physiological nocturnal BP fall was attenuated significantly in the study group for diastolic BP (11.5 ± 6.1 mmHg vs. 17.7 ± 7.1 mmHg, p = 0.006). Specifically, the number of patients with high nighttime systolic and diastolic BP SDS (p = 0.02 and p = 0.004, respectively) as well as elevated nighttime systolic (p = 0.03) and diastolic (p = 0.003) BPLs was found to be significantly higher than those in the controls. Alteration of the "normal" circadian rhythm is very frequent in liver transplant recipients. Thus, it is recommended to perform ABPM on all liver transplanted children not to underdiagnose HT.

Long-term outcomes of children after solid organ transplantation

“…Hypertension is common, as it is described in 50-75% of renal transplant recipients, and is associated with left ventricular hypertrophy (46,47). The prevalence of hypertension in liver transplant patients is reported to be 15-30% (48,49). Transplant recipients require 24-hour ambulatory blood pressure monitoring to unmask nocturnal hypertension (46,49,50).…”

The kidney in pediatric liver transplantation: An updated perspective

“…In addition, it affords the ability to assess for white coat, nocturnal, and masked hypertension, which are otherwise not detectable. Studies of ABPM in pediatric liver transplant patients have demonstrated a 30% prevalence of masked hypertension, surprisingly similar to the prevalence in children with primary renal causes of CKD . ABPM has also demonstrated a lack of physiologic decrease in blood pressure in nocturnal blood pressure in liver transplant patients as compared to controls.…”

“…Among adult liver transplant recipients, hypertensive CV disease, and renal failure are significant contributors to mortality, particularly long‐term mortality . While the exact prevalence of hypertension and the potential CV risk attributed to it in pediatric liver transplant patients remains unknown, the fact that hypertension is an independent risk factor for CKD in this population makes its negative impact clear enough. Additionally, childhood hypertension in general not only tracks to adulthood, but end‐organ hypertensive damage begins to manifest during childhood .…”

“…This “non‐dipping” is a strong risk factor for CV disease and mortality in adults. This effect in children has not yet been determined but is not present in health . As such, current American Heart Association recommendations call for the routine use of ABPM in children with CKD, as well as recipients of liver and other solid organ transplants .…”

Practice recommendations for the monitoring of renal function in pediatric non‐renal organ transplant recipients

“…Another important information drawn from 24‐h ABPM is to what extent blood pressure lowering occurs during night‐time, this phenomenon is called nocturnal dipping. Attenuation of dipping resulting in nocturnal hypertension has been described in pediatric patients after heart and liver transplantation.…”