Cardiovascular risk assessment in children following kidney transplantation

Abstract

CV diseases are the leading cause of death among patients with ESRD. RTX decreases the CV risk; however, it still remains definitely higher than that of the general population. Large multicenter and longitudinal studies are difficult to perform and hard end-points of CV events are usually missing among pediatric population. Thus, appropriate estimation of CV risk is of crucial importance to define the potential hazards and to evaluate the effect of treatments aimed to reduce the risk. A number of validated non-invasive methods are available to assess the extent of CV damage in adults, such as calcification scores, cIMT, aPWV, 24-h ABPM, AASI, and HRV; however, they need adaptation, standardization, and validation in pediatric studies. cIMT and PWV are the most promising methods, as pediatric normative values are already present. The up-to-date treatment of ESRD aims not only to save life, but to offer the patient a life expectancy approaching that of the healthy population and to ensure a reasonable quality of life.

Incidence and magnitude of post‐transplant cardiovascular disease after pediatric kidney transplantation: Risk factor analysis of 1058 pediatric kidney transplants at the university of Minnesota

“…Even then, because these patients have a significantly longer life expectancy than adult KT recipients, the propensity for early discovery and reduction of CVD manifestations on this population is of greater importance. While transplant care—immunosuppression, rejection and infection surveillance, cancer screening, renal function, and blood pressure management—in these patients is much more comprehensive, the overlap between disciplinary lines is less exhaustive for cardiovascular screening and health maintenance . Thus, in moving forward, the programmatic schema for the reduction in CVEs in pediatric KT recipients must entail aggressive implementation of conventional treatment and surveillance guidelines such as frequent cardiac rhythm assessment, low dose aspirin, and statin administration.…”

Donor-Recipient Size Mismatch in Paediatric Renal Transplantation

“…Studies that focused on the cardiovascular benefits that transplantation provides have shown that transplantation early in ESRF reduces the known cardiovascular risk factors associated with chronic kidney disease and long term dialysis [11]. Cardiovascular disease is responsible for the deaths of 36% of all children with end stage renal failure, 34% of those on dialysis and 11% of paediatric deaths after transplantation [12].…”

Conversion of Twice-Daily Tacrolimus to Once-Daily Tacrolimus Formulation in Stable Pediatric Kidney Transplant Recipients: Pharmacokinetics and Efficacy

“…Given these effects are related to the tacrolimus dose and concentration, Tac-OD may have beneficial effects on glucose metabolism and blood pressure due to low peak concentration compared with Tac-BID (26)(27)(28). In the clinical perspectives, these positive effects are quite important because cardiovascular disease is a leading cause of death after kidney transplantation in pediatrics as well as adults (29,30). Considering that Tac-OD can improve patient adherence to immunosuppressants by reducing barriers to adherence (Table S1), the beneficial effects of Tac-OD in the long-term outcome is certainly worth investigating.…”