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Factors associated with cardiovascular target organ damage in children after renal transplantation

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Abstract

Background

Cardiovascular disease is the second-most common cause of death in pediatric renal transplant recipients. The aim of this study was to evaluate subclinical cardiovascular target organ damage defined as the presence of arterio- and atherosclerotic lesions and cardiac remodeling and to analyze contributing risk factors in a large cohort of children after renal transplantation (RT).

Methods

A total of 109 children aged 13.1 ± 3.3 years who had undergone RT at one of three German transplant centers were enrolled in this study. Patients had been transplanted a mean of 5.5 (±4.0) years prior to being enrolled in the study. Anthropometric data, laboratory values and office- and 24-h ambulatory blood pressure monitoring (ABPM) were evaluated. Cardiovascular target organ damage was determined through non-invasive measurements of aortic pulse wave velocity (PWV), carotid intima–media thickness (IMT) and left ventricular mass (LVM).

Results

Elevated PWV or IMT values were detected in 22 and 58% of patients, respectively. Left ventricular hypertrophy was found in as many as 43% of patients. The prevalence of uncontrolled or untreated hypertension was 41%, of which 16% of cases were only detected by ABPM measurements. In the multivariable analysis, higher diastolic blood pressure, everolimus intake and lower estimated glomerular filtration rate were independently associated with high PWV. Higher systolic blood pressure and body mass index were associated with elevated LVM.

Conclusions

Our results showed an alarming burden of cardiovascular subclinical organ damage in children after RT. Hypertension, obesity, immunosuppressive regimen and renal function emerged as independent risk factors of organ damage. Whereas the latter is not modifiable, the results of our study strongly indicate that the management of children after RT should focus on the control of blood pressure and weight.

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Acknowledgments

This study has been made possible by grants of the German Federal Ministry of Education and Research (reference number: 01EO0802) and the Roche Organ Transplantation Research Foundation.

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Author notes

  1. Bianca Borchert-Mörlins, Daniela Thurn, Markus J. Kemper, Rainer Büscher and Anette Melk contributed equally to this work.

Authors and Affiliations

  1. Department of Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Germany

    Bianca Borchert-Mörlins, Daniela Thurn, Elena Bauer, Sabrina Baig, Nele Kanzelmeyer & Anette Melk

  2. Department of Nephrology, Hannover Medical School, Hannover, Germany

    Bernhard M. W. Schmidt

  3. Pediatric Nephrology, University Hospital, Essen, Germany

    Anja K. Büscher, Tanja Kier & Rainer Büscher

  4. Pediatric Nephrology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

    Jun Oh & Markus J. Kemper

  5. Department of Kidney, Liver and Metabolic Diseases, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany

    Anette Melk

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  1. Bianca Borchert-Mörlins
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Correspondence to Anette Melk.

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The study was approved by all three local medical ethics committees and all patients and parents gave written informed consent (# 504–2009). Procedures were carried out according to the Helsinki Declaration.

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Borchert-Mörlins, B., Thurn, D., Schmidt, B.M.W. et al. Factors associated with cardiovascular target organ damage in children after renal transplantation. Pediatr Nephrol 32, 2143–2154 (2017). https://doi.org/10.1007/s00467-017-3771-8

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