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Antihypertensive Medication and Renal Allograft Failure

A NorthAmerican Pediatric Renal Transplant Cooperative Study Report

JONATHAN M. SOROF^*, E. KENNETH SULLIVAN, AMIR TEJANI and RONALD J. PORTMAN^§

^* Department of Pediatrics, Baylor College of Medicine, Houston, Texas
EMMES Corporation, Potomac, Maryland
Departments of Pediatrics and Surgery, New York Medical College, Valhalla, New York
^§ Department of Pediatrics, University of Texas Medical School, Houston, Texas.

Correspondence to Dr. Jonathan M. Sorof, c/o NAPRTCS Operations Manager, 19 Bradhurst Avenue, Box 10, Hawthorne, NY 10532-2140. Phone: 914-345-0416; Fax: 914-345-0229; E-mail: jsorof{at}texaschildrenshospital.org

Abstract. Hypertension after renal transplantation occurs commonly and, in adults, is associated with decreased graft survival. The North American Pediatric Renal Transplant Cooperative Study database was analyzed to determine: (1) the percent use of antihypertensive (anti-HTN) medication based on donor type, race, age, and acute rejection status; and (2) whether use of anti-HTN medication is associated with higher rates of subsequent graft failure. Data regarding anti-HTN medication use was available in 5251 renal allografts (4821 patients) with >30 d graft function. Posttransplant follow-up data were collected at 30 d, 6 mo, 12 mo, and then annually for 5 yr. At each follow-up, patients were selected for further analysis if the graft was functioning at that visit and subsequent follow-up data were available. Overall, anti-HTN medication use was 79% on day 30 and 58% at 5 yr. At each follow-up, anti-HTN medication use was higher (P < 0.01) for cadaveric donor versus living related donor, blacks versus whites, age >12 versus <12 yr, and 1 versus 0 acute rejection episodes. Anti-HTN medication use at each annual follow-up was associated with significantly higher rates of subsequent graft failure. Multiple regression analysis controlling for all factors associated with increased use of anti-HTN medications revealed a relative risk of graft failure for use of anti-HTN medication of greater than 1.4 (P < 0.001). In recipients of cadaveric allografts, only acute rejection status predicted subsequent graft failure more strongly than use of anti-HTN medications. These data suggest that hypertension after renal transplantation in children, as evidenced by use of anti-HTN medications, is associated with increased rates of subsequent graft failure.

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Copyright © 2008 by the American Society of Nephrology. Online ISSN: 1533-3450 Print ISSN: 1046-6673