Antihypertensive Pharmacotherapy and Long-Term Outcomes in Pediatric Kidney Transplantation

摘要

Hypertension (HTN) is common in pediatric recipients following kidney transplantation (KT). We retrospectively assessed the impact of HTN on long-term (>10-year) outcomes in pediatric (aged <18 years) recipients at our center. 293 pediatric KT recipients (83% living donor [LD]) with graft survival (GS) for ≥5 years were studied. HTN was defined by antihypertensive medication use at 5 years post-KT. 160 (55%) recipients did not have HTN and 133 (45%) had HTN at 5 years post-KT. There were no differences in actuarial patient survival between cohorts. Actuarial GS at 15 and 20 years was 68% and 53% for recipients without HTN, and 53% and 33% for recipients with HTN (p=0.006). Among LD recipients using 1 antihypertensive, GS at 15 years was 100% for those using an angiotensin converting enzyme inhibitor (ACEI), and 44% for those not using an ACEI (p=0.04). Among these recipients, HTN treated with no ACEI was a significant risk factor for graft failure at >5 years (hazard ratio [HR] = 2.5, p=0.02), but HTN treated with an ACEI was not (HR=0.6, p=0.7). HTN at 5 years post-KT is associated with poorer long-term GS in pediatric recipients, but ACEI therapy may enable better outcomes and should be studied further.