Antihypertensive medication and renal allograft failure: a North American Pediatric Renal Transplant Cooperative Study report.

Publication Type
Journal Article
Year of Publication
Sorof, J M; Sullivan, E K; Tejani, A; Portman, R J
J Am Soc Nephrol
Date Published
1999 Jun
Age Distribution; Antihypertensive Agents; Child; Child, Preschool; Female; Follow-Up Studies; Graft Rejection; Humans; hypertension; Infant; Infant, Newborn; Kidney Failure, Chronic; kidney transplantation; Male; Prevalence; Proportional Hazards Models; Registries; Regression Analysis; Risk Factors; Transplantation, Homologous; United States

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 > or = 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.