Short-term pediatric renal transplant survival: Blood pressure and allograft function

Hypertension is prevalent after renal transplantation (Tx) and associated with graft failure in children and adults. However, the effect of blood pressure (BP) on short-term renal allograft function is uncertain. We assessed the associations among BP pretransplant, and 3 months and 1 yr post-transplant. and l-yr post-transplant measured glomerular filtration rate (mGFR) in 61 children with a functioning graft. The GFR was determined using a single intravenous (i.v.) injection of Optiray 350((R)). Data were collected between January 1994 and January 2000. The mean mGFR 1 yr after renal transplant was 63.6 +/- 19.9 mL/min/1.73 m(2) in 26 live donor recipients and 50.8 +/- 23.3 mL/min/1.73 m(2) in 35 cadaveric donors (p = 0.029). Correlation analysis showed significant negative associations of l-yr mGFR with systolic blood pressure (SBP) and diastolic blood pressure (DBP) 3 months after renal Tx (r=-0.58, p <0.0001 and r=-0.50, p <0.0001, respectively), and with SEP (r=-0.37, p = 0.003) and DBP (r=-0.32, p = 0.01) 1 yr after renal Tx. Multi-variate regression analysis showed that the SEP 3 months after Tx (p <0.001), number of acute rejections (p = 0.002), donor age (p = 0.02), and cold ischemia time (p = 0.03) were independent predictors for the l-yr mGFR. These results indicate that a higher SEP in the first few months post-renal Tx is associated with decreased renal allograft function in children 1 yr post-Tx.