Analysis of hypertension in children post renal transplantation ?a report of the North American Pediatric Renal Transplant Cooperative Study (NAPRTCS)

Abstract

Hypertension is common in children after renal transplantation and is associated with multiple factors. Data regarding the prevalence of post-transplant hypertension and the relationship between immunosuppressive drugs and the persistence of hypertension in a large population of North American children have not been available. This study was designed by the North American Pediatric Renal Transplant Cooperative Study to evaluate in a large diverse multicenter population of children the prevalence of hypertension post transplantation, the type of antihypertensive medications used to treat this hypertension and to determine the relationship between the blood pressure control and the immunosuppressive therapy. Analysis of 277 patients showed the following: (1) 70% of recipients required antihypertensive medications 1 month post transplant compared with 48% pre transplant; the incidence decreased to 59% at 24 months; (2) the majority of children received multiple drug therapy to control blood pressure; (3) hypertension can be controlled effectively despite inherent etiological factors, such as allograft source, prior hypertension and immunosuppressive therapy.

Prevention of Post-transplant Cardiovascular Disease – Report and Recommendations of an Ad Hoc Group

“…Hypertension prevalence greater than 80% has been reported in children after kidney transplants (87)(88)(89)(90). In a small study of pediatric kidney recipients followed 7-86 months post-transplant, systolic hypertension was associated with development of left ventricular hypertrophy -a risk factor for…”

Methylprednisolone Exposure in Pediatric Renal Transplant Patients

“…Obesity is also associated with elevated blood pressure in children (36)(37)(38). After renal TX, hypertension is common and associated with multifactorial etiology, including immunosuppressive drugs (39). Taken together, school-aged TX patients are encountered with considerable risk for obesity.…”

Traditional drug therapy of hypertension in transplant recipients

“…Although diuretics may not be commonly used as first-line treatment in many transplant centres, it is common practice to add diuretics when the chosen first-line treatment is not sufficiently lowering the BP. 9 There are, however, some concerns and possible disadvantages of diuretics, which limits their use as first-line agents in some centres. Heart transplant centres are understandably wary of the potential of diuretics to aggravate (or cause) hypokalaemia and hypomagnesaemia (which have been associated in some studies with cardiac dysrhythmias), and dyslipidaemia (which is typically a major problem for most cardiac transplant recipients 7 ).…”

“…Some centres estimate that 70-85% of cyclosporintreated patients eventually require antihypertensive drug therapy. 9 There is hope that tacrolimus 43,44 (FK506) or new preparations of cyclosporin 20 will limit the need for antihypertensive drug therapy in the future.…”

“…Most physicians working in transplantation centres are acutely aware of the need to avoid re-transplantation, because obtaining a second donor organ for a given patient is typically very difficult. Most nephrologists therefore work very hard at avoiding renal impairment in renal transplant recipients, [9][10][11] but some have begun to realise that long-term survival in renal transplant recipients is often limited by the development of cardiovascular disease. 12 Many cardiologists and cardiac surgeons attempt to avoid the early atherosclerosis and left ventricular dysfunction which are commonly seen in transplanted hearts when the BP is not well controlled.…”