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Antihypertensive pharmacotherapy and long‐term outcomes in pediatric kidney transplantation
Author(s) -
Suszynski Thomas M.,
Rizzari Michael D.,
Gillingham Kristen J.,
Rheault Michelle N.,
Kraszkiewicz Wojciech,
Matas Arthur J.,
Chavers Blanche M.
Publication year - 2013
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/ctr.12125
Subject(s) - medicine , hazard ratio , transplantation , kidney transplantation , single center , angiotensin converting enzyme , risk factor , pediatrics , blood pressure , confidence interval
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 < 18 yr) at our center. Two hundred and ninety‐three pediatric KT recipients (83% living donor [ LD ]) with graft survival ( GS ) for ≥5 yr were studied. HTN was defined by antihypertensive medication use at five yr post‐ KT . One hundred and sixty (55%) recipients did not have HTN , and 133 (45%) had HTN at five yr post‐ KT . There were no differences in actuarial patient survival between cohorts. Actuarial GS at 15 and 20 yr 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 15 yr 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 yr (hazard ratio [ HR ] = 2.5, p = 0.02), but HTN treated with an ACEI was not ( HR  = 0.6, p = 0.7). HTN at five yr post‐ KT is associated with poorer long‐term GS in pediatric recipients, but ACEI therapy may enable better outcomes and should be studied further.

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