Antihypertensive pharmacotherapy and long‐term outcomes in pediatric kidney transplantation

Abstract

Hypertension (HTN) is common in pediatric recipients following kidney transplantation (KT). We retrospectively assessed the impact of HTN on long-term (>10-yr) outcomes in pediatric KT recipients (aged<18yr) at our center. Two hundred and ninety-three pediatric KT recipients (83% living donor [LD]) with graft survival (GS) for ≥5yr were studied. HTN was defined by antihypertensive medication use at fiveyr post-KT. One hundred and sixty (55%) recipients did not have HTN, and 133 (45%) had HTN at fiveyr post-KT. There were no differences in actuarial patient survival between cohorts. Actuarial GS at 15 and 20yr was 68% and 53% for recipients without HTN, and 53% and 33% for recipients with HTN (p=0.006). Among LD recipients using one antihypertensive, GS at 15yr 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 >5yr (hazard ratio [HR]=2.5, p=0.02), but HTN treated with an ACEI was not (HR=0.6, p=0.7). HTN at fiveyr post-KT is associated with poorer long-term GS in pediatric recipients, but ACEI therapy may enable better outcomes and should be studied further.