Pediatric Nephrology Fellow Lucile Packard Children's Hospital Stanford Palo Alto, California, United States
Background: When children are afflicted with end-stage kidney disease, the best long-term treatment is a kidney transplant. However, the donor kidney is almost always from an adult and much larger than age-appropriate for a child. The balance of a small heart trying to perfuse a big kidney presents a dilemma about appropriate blood pressure targets especially in the immediate post-transplant period. Objective: (1) to describe blood pressures at various timepoints among renal transplant recipients within 1 year after transplantation, including in the immediate post-transplant hospitalization period, clinic visits, and through the ambulatory blood pressure monitoring program at 6 and 12 months post-transplant (2) to determine the relationship between blood pressure measurements and the outcomes of left ventricular hypertrophy (echocardiogram) and subcapsular cortical atrophy (protocol allograft biopsy) at 6 and 12 months post-transplant Design/Methods: In this retrospective cohort study at a single academic center, pediatric patients who underwent kidney-only transplantation from 2014-2022 with at least 6-month follow-up were included (n=250). Blood pressure measurements in the post-operative period and in the clinic setting and 6- and 12-month protocol measurements will be collected including: ambulatory blood pressure monitor readings, echocardiograms, and biopsies. A descriptive distribution of post-transplant blood pressure z-scores will be depicted. The association of blood pressures will be compared with the following primary outcomes 1) left ventricular hypertrophy on echocardiogram and (2) isolated subcapsular cortical atrophy on biopsy. Adjusted analyses will include donor age, donor type, indication for transplantation, previous diagnosis of hypertension, medications in Cox models. This study was approved by the IRB (protocol #68090). We are currently in the data collection stage and have extracted data from the electronic medical record. The next steps include manual chart review and data cleaning and analyses, with expected completion by 12/31/2023.
