Antihypertensive medication and renal allograft failure: A North American pediatric renal transplant cooperative study report

Hypertension after renal transplantation occurs commonly and, in adults, is associated with decreased graft survival. The North American Pediatric Ren al Transplant Cooperative Study database was analyzed to determine: (I) 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 med ication is associated with higher rates of subsequent graft failure. Data r egarding anti-HTN medication use was available in 5251 renal allografts (48 21 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 functionin g 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, a nti-HTN medication use was higher (P < 0.01) for cadaveric donor vel sns li ving related donor, blacks versus whites, age >12 versus <12 yr, and greate r than or equal to 1 versus 0 acute rejection episodes. Anti-HTN medication use at each annual follow-up was associated with significantly higher rate s 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 re jection status predicted subsequent graft failure more strongly than use of anti-HTN medications. These data suggest that hypertension after renal tra nsplantation in children, as evidenced by use of anti-HTN medications, is a ssociated with increased rates of subsequent graft failure.