ESPN 51th Annual Meeting

ESPN 2018


 
Hypertension in the Pediatric Kidney Transplant Recipients
AHMET KESKİNOGLU 1 SEVGIN TANER 1 İPEK KAPLAN BULUT 1 İLKE BAŞ 1 SURIYE OZGUR 2 PEMBE KESKİNOGLU 3 CANER KABASAKAL 1

1- EGE UNIVERSITY MEDICINE FACULTY DEPARTMENT OF PEDIATRICS, PEDIATRIC NEPHROLOGY
2- EGE UNIVERSITY MEDICINE FACULTY DEPARTMENT OF BIOSTATISTICS AND MEDICAL INFORMATICS
3- DOKUZ EYLUL UNIVERSITY MEDICINE FACULTY DEPARTMENT OF BIOSTATISTICS AND MEDICAL INFORMATICS
 
Introduction:

 Kidney transplantation is the optimal therapy for patients with end-stage renal diseases. The graft survival is important for long-term survival in the pediatric recipients. Hypertension after kidney transplant is a frequent occurence in pediatric patients and it is an important risk factor for graft loss. The main purpose is to determine the effect of pre- and post-transplantation hypertension on kidney dysfunction in pediatric recipients.

Material and methods:

 In this study, the data of 102 pediatric recipients admitted to Ege University Faculty of Medicine Childrens Hospital were evaluated retrospectively. In this study retrospective cohort study design was conducted. The results of the follow-up cohort was children with renal recipients. The dependent variable of the study is the development of kidney dysfunction after transplantation.  Hypertension has been investigated as the main independent variable which is effect dysfunction. Demographic characteristics of children, primary disease which were leads to renal failure and HLA matching at transplantation were analyzed as covariate variables. Categorical variables were defined by number and percentage and compared with the chi-square analysis.  Continuous variables were presented by means ± standard deviations and t test were used for comparisons. Non-parametric tests were used evaluate where normality violated. 

Results:

 There were 102 transplantations, 56 of whom wre boys (54.9%),and 46 were girls (45.1%). The mean age of our study subjects was10.5 ± 4.4 years with a range of 0-19 years). The main causes of renal transplantation were urological disorders (38.2%) and glomerular and genetic disease (57.8%), while primary disease of 4 patients was unknown. Hypertension was present in 62 patients (60.8%) before transplantation and 73 (71.6%) had hypertension in the post-renal transplant period. Pre-renal transplant hypertension was detected in 59.0% of 39 patients with urological disease, 55.9% of 34 patients with genetic disease and 76.0% of 25 patients with glomerular disease. There was no gender difference before and after transplantation. The mean age of those with and without hypertension was not different. The prevalence of hypertension was not different according to the primary disease (p = 0.250). Patients were grouped with HLA-A, B, and DR tissue incompatibility score under/up 5. Hypertension prevalence was significantly higher in patients with high tissue imcompatibility score after transplantation (p = 0.042). 19 patients had hypertension after transplantation. Dysfunction developed in 4 (21.1%) of 19 patients and 8 (42.1%) of them were donor cadavers. The prevalence of renal dysfunction was not increased in patients with pre-transplant hypertension, in all hypertensive patients after transplantation and in new hypertensive patients after transplantaion (p= 0.317, p=0.207 and p=0.410, respectively). It was determined that the examination and follow-ups of the patients were performed in accordance with the determined guidelines, and the continuity of treatment occured.

Conclusions:

In our study,  it was found that hypertension in the pediatric patients had no effect on the development of graft dysfunction. It is noteworthy that post transplantation hypertension prevalence is higher in children with high tissue incompatibility score. However,  there is a need for larger sample studies to evaluate the effect of hypertension on graft dysfunction.