24H ARTERIAL BLOOD-PRESSURE PROFILES IN C HILDREN AFTER ORTHOTOPIC LIVER-TRANSPLANTATION

Problem: An arterial hypertension is frequently observed in adults aft er organ transplantation due to the treatment with the hypertensiogeni c drugs Cyclosporin A, FK 506 or prednisolone. Hardly any data exist a bout the blood pressure profile of children after orthotopic liver tra nsplantation. Method: Therefore we studied ambulatory blood pressure ( ABP) in 19 children aged 0.9 to 18.3 years (median value: 10.9 yrs) wh o had received an orthotopic liver transplant 0.28 to 12.3 yrs before ABP measurement. All patients received prednisolone (1,12-7,3 mg/m(2)/ d); additionally, 13 patients received cyclosporine (91-45 mg/m(2)/d); the other 6 were given tacrolimus (FK 506) in doses from 0.6 to 4 mg/ m(2)/d for prevention of graft rejection. For ABP recording, automatic measurements were taken every 15 minutes during the daytime (i.e., be tween 6.00 and 22.00 h),and every half hour in the night (i.e., betwee n 22.00 and 6.00 h). From these measurements, mean systolic and diasto lic blood pressures for the day acid for the night were calculated sep arately. These calculated mean values were compared to 95th centiles f or normotensive paediatric populations of comparable body length. Resu lts: Eight out of the 19 liver graft recipients had pathologically ele vated mean blood pressure values. Arterial hypertension had been known to exist before the ABP measurement in only three of them. Mean systo lic and diastolic blood pressure values were elevated in the day and i n the night in four children. Un one child both mean values for the da y plus the mean diastolic value at night were elevated. One child had elevated mean systolic values at day and night. In two children, only one value was above the 95th centile: in one the mean systolic pressur e at day,and in the other the mean systolic pressure at night. Four of the six children with 2-4 elevated mean blood pressure values had rai sed values for serum creatinine and/or an abnormally low glomerular fi ltration rate. Conclusion: Arterial hypertension after paediatric orth otopic liver transplantation is relatively frequent although less than after renal transplantation. lt is associated with a reduced glomerul ar filtration rate. Thus a cyclosporine-induced renal lesion might be one of the factors causing hypertension after liver transplantation.