Antihypertensive Treatment in the Immediate Post-Operative Period and One-Year after Pediatric Heart Transplantation

Abstract

Purpose Hypertension (HTN) is a known complication of pediatric heart transplant (HTx) both immediately post-Tx and long-term. We sought to identify factors associated with antihypertensive medication (anti-HTN) use in pediatric HTx recipients in the ICU post-Tx, and need for oral anti-HTNs at post-Tx discharge (d/c) and 1 year (yr) post-Tx. Methods Retrospective chart review of patients (pts) ≤18 years who underwent initial HTx at UPMC Children's Hospital of Pittsburgh and Morgan Stanley Children's Hospital of NY between 8/1/09-12/31/17 with ≥1 yr follow-up. Exclusion criteria included re-Tx, multi-organ recipients, pts who survived Results There were 188 pts who met inclusion criteria. Anti-HTN drips were required in the ICU post-Tx in 46 pts (24.5%) for a median of 3 days (1-21 days). Drips were nitroprusside (28/46), calcium channel blocker (8/46), beta-blocker (1/46) and multiple (9/46). Oral anti-HTNs were required in 58 pts (30.9%) at d/c and 1 yr post-Tx. Figure 1 demonstrates significant associations by univariate and multivariate analyses. Anti-HTN drip in the ICU post-Tx was associated with donor-to-recipient weight ratio (wt ratio). Oral anti-HTN use at d/c was associated with wt ratio and pre-Tx VAD, and at 1 yr post-Tx was associated with age at Tx, steroid use at d/c and oral anti-HTN use at d/c. Conclusion HTN is common immediately and at 1 yr post-Tx, with over a quarter of pts requiring anti-HTNs. Wt ratio was the only independent predictor of anti-HTN use in the early post-Tx period, whereas VAD use was also associated with anti-HTN use at d/c. Interestingly, anti-HTN use at 1 yr post-Tx was not associated with those factors, but rather with age at Tx and steroid use.