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Hypertension in Pediatric Solid Organ Transplant Recipients

  • Pediatric Hypertension (C Hanevold, Section Editor)
  • Published:
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Abstract

Purpose of Review

To review the current literature regarding hypertension (HTN) following pediatric solid organ transplant (SOTx), including definition, prevalence, risk factors, outcomes, and treatment.

Recent Findings

In recent years several new guidelines for the definition, monitoring, and management of pediatric HTN have been published, but with no specific recommendations regarding SOTx recipients. HTN remains highly prevalent, yet underdiagnosed and undertreated in kidney transplant (KTx) recipients, especially when ambulatory blood pressure monitoring (ABPM) is utilized. There are little data regarding its prevalence in other SOTx recipients. HTN in this population is multifactorial and is associated with HTN status prior to Tx, demographic factors (age, sex, and race), weight status, and immunosuppression protocol. HTN is associated with subclinical cardiovascular (CV) end-organ damage, including left ventricular hypertrophy (LVH) and arterial stiffness, yet there are no recent data regarding its long-term outcomes. There are also no updated recommendations regarding the optimal management of HTN in this population.

Summary

Given its high prevalence and the young age of this population facing years at increased CV risk, post-Tx HTN requires more clinical attention (routine monitoring, frequent application of ABPM, better BP control). Additional research is needed for a better understanding of its long-term outcomes as well as its treatment and treatment goals. Much more research is needed regarding HTN in other pediatric SOTx populations.

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References

Papers of particular interest, published recently, have been highlighted as: •   Of importance •• Of major importance

  1. Weir MR, Burgess ED, Cooper JE, Fenves AZ, Goldsmith D, McKay D, et al. Assessment and management of hypertension in transplant patients. J Am Soc Nephrol. 2015;26(6):1248–60.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Gülhan B, Topaloğlu R, Karabulut E, Ozaltın F, Aki FT, Bilginer Y, et al. Post-transplant hypertension in pediatric kidney transplant recipients. Pediatr Nephrol. 2014;29(6):1075–80.

    Article  PubMed  Google Scholar 

  3. Kitzmueller E, Vécsei A, Pichler J, Böhm M, Müller T, Vargha R, et al. Changes of blood pressure and left ventricular mass in pediatric renal transplantation. Pediatr Nephrol. 2004;19(12):1385–9.

    Article  PubMed  Google Scholar 

  4. Jacobi J, Rockstroh J, John S, Schreiber M, Schlaich MP, Neumayer HH, et al. Prospective analysis of the value of 24-hour ambulatory blood pressure on renal function after kidney transplantation. Transplantation. 2000;70(5):819–27.

    Article  CAS  PubMed  Google Scholar 

  5. Mitsnefes MM, Khoury PR, McEnery PT. Early posttransplantation hypertension and poor long-term renal allograft survival in pediatric patients. J Pediatr. 2003;143(1):98–103.

    Article  PubMed  Google Scholar 

  6. Flynn JT, Kaelber DC, Baker-Smith CM, Blowey D, Carroll AE, Daniels SR, et al. Clinical practice guideline for screening and management of high blood pressure in children and adolescents. Pediatrics. 2017;140(3).

  7. Flynn JT, Urbina EM, Brady TM, Baker-Smith C, Daniels SR, Hayman LL, et al. Ambulatory blood pressure monitoring in children and adolescents: 2022 update: a scientific statement from the american heart association. Hypertension. 2022;23:101161HYP0000000000000215.

  8. Lurbe E, Agabiti-Rosei E, Cruickshank JK, Dominiczak A, Erdine S, Hirth A, et al. 2016 European Society of Hypertension guidelines for the management of high blood pressure in children and adolescents. J Hypertens. 2016;34(10):1887–920.

    Article  CAS  PubMed  Google Scholar 

  9. Kidney Disease: Improving Global Outcomes (KDIGO) Blood Pressure Work Group. KDIGO. clinical practice guideline for the management of blood pressure in chronic kidney disease. Kidney Int. 2021;99(3S):S1–87.

    Google Scholar 

  10. National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents. The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics. 2004;114(2 Suppl 4th Report):555–576.

  11. Wühl E, Witte K, Soergel M, Mehls O, Schaefer F, German Working Group on Pediatric Hypertension. Distribution of 24-h ambulatory blood pressure in children: normalized reference values and role of body dimensions. J Hypertens. 2002;20(10):1995–2007.

  12. ESCAPE Trial Group, Wühl E, Trivelli A, Picca S, Litwin M, Peco-Antic A, et al. Strict blood-pressure control and progression of renal failure in children. N Engl J Med. 2009;361(17):1639–1650.

  13. Seeman T, Vondrák K, Dušek J. Effects of the strict control of blood pressure in pediatric renal transplant recipients-ESCORT trial. Pediatr Transplant. 2019;23(1):e13329.

    PubMed  Google Scholar 

  14. Seifert ME, Dahale DS, Kamel M, Winterberg PD, Barletta GM, Belsha CW, et al. The improving renal outcomes collaborative: blood pressure measurement in transplant recipients. Pediatrics. 2020;146(1).

  15. Wu JGA, Tong A, Evangelidis N, Manera KE, Hanson CS, Baumgart A, et al. Patient and caregiver perspectives on blood pressure in children with chronic kidney disease. Nephrol Dial Transplant. 2021.

  16. Borchert-Mörlins B, Thurn D, Schmidt BMW, Büscher AK, Oh J, Kier T, et al. Factors associated with cardiovascular target organ damage in children after renal transplantation. Pediatr Nephrol. 2017;32(11):2143–54.

    Article  PubMed  Google Scholar 

  17. Höcker B, Weber LT, John U, Drube J, Fehrenbach H, Klaus G, et al. Steroid withdrawal improves blood pressure control and nocturnal dipping in pediatric renal transplant recipients: analysis of a prospective, randomized, controlled trial. Pediatr Nephrol. 2019;34(2):341–8.

    Article  PubMed  Google Scholar 

  18. Rumman RK, Ramroop R, Chanchlani R, Ghany M, Hebert D, Harvey EA, et al. Longitudinal assessment of myocardial function in childhood chronic kidney disease, during dialysis, and following kidney transplantation. Pediatr Nephrol. 2017;32(8):1401–10.

    Article  PubMed  Google Scholar 

  19. Thorsteinsdottir H, Christensen JJ, Holven KB, Tveiterås M, Brun H, Åsberg A, et al. Cardiovascular risk factors are inversely associated with omega-3 polyunsaturated fatty acid plasma levels in pediatric kidney transplant recipients. J Ren Nutr. 2020.

  20. Santos LB, Borges LM, Souza LV, Felipe CR, Medina-Pestana JO, do Carmo Franco M. Is low birth weight an additional risk factor for hypertension in paediatric patients after kidney transplantation? J Dev Orig Health Dis. 2020;11(1):3–6.

  21. Blöte R, Memaran N, Borchert-Mörlins B, Thurn-Valsassina D, Goldschmidt I, Beier R, et al. Greater susceptibility for metabolic syndrome in pediatric solid organ and stem cell transplant recipients. Transplantation. 2019;103(11):2423–33.

    Article  PubMed  Google Scholar 

  22. Tangnararatchakit K, Kongkhanin U, Katanyuwong P, Saisawat P, Chantarogh S, Pirojsakul K. Inadequate blood pressure control demonstrated by ambulatory blood pressure monitoring in pediatric renal transplant recipients. Pediatr Transplant. 2019;23(6):e13499.

    Article  PubMed  Google Scholar 

  23. •• Sugianto RI, Schmidt BMW, Memaran N, Duzova A, Topaloglu R, Seeman T, et al. Sex and age as determinants for high blood pressure in pediatric renal transplant recipients: a longitudinal analysis of the CERTAIN Registry. Pediatr Nephrol. 2020;35(3):415–426. A large study following a cohort up to 3 years post KTx, and analyzing the prevalence and risk factors for HTN.

  24. Hamdani G, Nehus EJ, Hanevold CD, Sebestyen Van Sickle J, Woroniecki R, Wenderfer SE, et al. Ambulatory blood pressure, left ventricular hypertrophy, and allograft function in children and young adults after kidney transplantation. Transplantation. 2017;101(1):150–156.

  25. Pais P, Dello Strologo L, Iyengar A, Velusamy V, Greenbaum LA. Nocturnal hypertension and left ventricular hypertrophy in pediatric renal transplant recipients in South India. Pediatr Transplant. 2020;24(4):e13710.

    Article  PubMed  Google Scholar 

  26. Villasís-Keever MA, Zurita-Cruz JN, Serret-Montoya J, de Leon-Herrera AP, Galván-Heredia P, Zepeda-Martínez CDC, et al. Cardiometabolic factors in pediatric patients with chronic diseases. Arch Med Res. 2021.

  27. Végh A, Bárczi A, Cseprekál O, Kis É, Kelen K, Török S, et al. Follow-up of blood pressure, arterial stiffness, and GFR in pediatric kidney transplant recipients. Front Med (Lausanne). 2021;16(8):800580.

    Article  Google Scholar 

  28. Bárczi A, Lakatos BK, Szilágyi M, Kis É, Cseprekál O, Fábián A, et al. Subclinical cardiac dysfunction in pediatric kidney transplant recipients identified by speckle-tracking echocardiography. Pediatr Nephrol. 2022.

  29. Taylor VA, Kirby CL, Nehus EJ, Goebel J, Hooper DK. Composite health outcomes in pediatric and young adult kidney transplant recipients. J Pediatr. 2019;204:196–202.

    Article  PubMed  Google Scholar 

  30. Alparslan C, Yavascan O, Doğan MS, Saritas S, Mutlubas Ozsan F, Kasap Demir B, et al. Pretransplant stable systolic cardiac functions play an important role in short-term systolic cardiac functions after kidney transplant in children. Exp Clin Transplant. 2017;15(1):34–9.

    PubMed  Google Scholar 

  31. Schmidt BMW, Sugianto RI, Thurn D, Azukaitis K, Bayazit AK, Canpolat N, et al. Early effects of renal replacement therapy on cardiovascular comorbidity in children with end-stage kidney disease: findings from the 4C-T study. Transplantation. 2018;102(3):484–92.

    Article  PubMed  Google Scholar 

  32. Ramoğlu MG, Uçar T, Yılmaz S, Özçakar ZB, Kurt-Şükür ED, Tutar E, et al. Hypertension and improved left ventricular mass index in children after renal transplantation. Pediatr Transplant. 2017;21(8).

  33. Hamdani G, Nehus EJ, Hanevold CD, VanSickle JS, Hooper DK, Blowey D, et al. Ambulatory blood pressure control in children and young adults after kidney transplantation. Am J Hypertens. 2017;30(10):1039–46.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Vafaei F, Dehghani SM, Malekhoseini SA, Karamifar H, Nikeghbalian S. Prevalence of postoperation metabolic syndrome in pediatric liver transplant patients: a single center experience. Exp Clin Transplant. 2018;16(5):582–7.

    PubMed  Google Scholar 

  35. Dégi AA, Bárczi A, Szabó D, Kis É, Reusz GS, Dezsőfi A. Cardiovascular risk assessment in pediatric liver transplant patients. J Pediatr Gastroenterol Nutr. 2019;68(3):377–83.

    Article  PubMed  Google Scholar 

  36. Mager DR, Hager A, Siminoski K, Yap JK, Gilmour SM. Healthy body weights with corticosteroid-free immunosuppression is the best predictor of cardiovascular health in children after liver transplantation. J Pediatr Gastroenterol Nutr. 2019;68(5):713–9.

    Article  PubMed  Google Scholar 

  37. Roblin E, Dumortier J, Di Filippo M, Collardeau-Frachon S, Sassolas A, Peretti N, et al. Lipid profile and cardiovascular risk factors in pediatric liver transplant recipients. Pediatr Transplant. 2016;20(2):241–8.

    Article  CAS  PubMed  Google Scholar 

  38. Naeser V, Brandt AH, Nyhuus B, Borgwardt L, Jørgensen MH, Rasmussen A. Risk markers for later cardiovascular diseases in liver-transplanted children and adolescents. Pediatr Transplant. 2018;22(8):e13298.

    Article  PubMed  Google Scholar 

  39. Memaran N, Borchert-Mörlins B, Schmidt BMW, Sugianto RI, Wilke H, Blöte R, et al. High burden of subclinical cardiovascular target organ damage after pediatric liver transplantation. Liver Transpl. 2019;25(5):752–62.

    Article  PubMed  Google Scholar 

  40. Chambers JH, Zerofsky M, Lustig RH, Rosenthal P, Perito ER. Diet and exercise in pediatric liver transplant recipients: behaviors and association with metabolic syndrome. J Pediatr Gastroenterol Nutr. 2019;68(1):81–8.

    Article  PubMed  PubMed Central  Google Scholar 

  41. • Arikanoğlu E, Tabel Y, Selimoğlu A. Evaluation of arterial hypertension by ambulatory blood pressure monitoring in pediatric liver transplant recipients. Blood Press Monit. 2021. A small study which apllied ABPM to evaluate BP status post LTx, revealing high prevalence of masked HTN.

  42. Hilk K, Zerofsky M, Rhee S, Rosenthal P, Perito ER. Center variation in screening for and management of metabolic syndrome in pediatric liver transplant recipients: a survey of SPLIT centers. Pediatr Transplant. 2019;23(3):e13347.

    Article  PubMed  PubMed Central  Google Scholar 

  43. • Memaran N, Onnen M, Müller C, Schwerk N, Carlens J, Borchert-Mörlins B, et al. Cardiovascular burden is high in pediatric lung transplant recipients. Transplantation. 2022. A small study following LuTx recipients and revealing high prevalence of HTN, and its association with arterial stiffness.

  44. Bechtold SM, Rohrer TR, Raile K, Hofer S, Thon A, Boettcher C, et al. Diabetes mellitus in pediatric solid organ recipients without and with cystic fibrosis: an analysis from the German-Austrian diabetes database (Diabetes Patienten Verlaufsdokumentation). Pediatr Diabetes. 2018;19(7):1191–7.

    Article  PubMed  Google Scholar 

  45. Kerstein JS, Donovan DJ, Zinn MD, Richmond ME, Cheung EW, Addonizio LJ, et al. Anti-hypertensive treatment in the immediate post-operative period and 1 year after pediatric heart transplantation. Pediatr Transplant. 2020;21:e13801.

    Google Scholar 

  46. Wagner SJ, Turek JW, Maldonado J, Staron M, Edens RE. Less is more in post pediatric heart transplant care. Ann Thorac Surg. 2019;107(1):165–71.

    Article  PubMed  Google Scholar 

  47. Weitz M, Laube GF, Schmidt M, Krupka K, Murer L, Müller D, et al. Outcome of renal transplantation in small infants: a match-controlled analysis. Pediatr Nephrol. 2018;33(6):1057–68.

    Article  PubMed  Google Scholar 

  48. Tjaden LA, Jager KJ, Bonthuis M, Kuehni CE, Lilien MR, Seeman T, et al. Racial variation in cardiovascular disease risk factors among European children on renal replacement therapy-results from the European Society for Paediatric Nephrology/European Renal Association - European Dialysis and Transplant Association Registry. Nephrol Dial Transplant. 2017;32(11):1908–17.

    Article  PubMed  Google Scholar 

  49. Sgambat K, Clauss S, Moudgil A. Comparison of BMI, waist circumference, and waist-to-height ratio for identification of subclinical cardiovascular risk in pediatric kidney transplant recipients. Pediatr Transplant. 2018;22(8):e13300.

    Article  PubMed  Google Scholar 

  50. • Jain A, Daoud D, Kees-Folts D, Freeman MA, Butt F, Abendroth CS, et al. Steroid-free maintenance immunosuppression using alemtuzumab in pediatric kidney transplantation: long-term longitudinal follow-up. Pediatr Transplant. 2021;e14173. Low prevalence of HTN in KTx recipients on steroid-free maintenance immunosuppression after alemtuzumab induction.

  51. Ruben S, Kreuzer M, Büscher A, Büscher R, Thumfart J, Querfeld U, et al. Impaired microcirculation in children after kidney transplantation: everolimus versus mycophenolate based immunosuppression regimen. Kidney Blood Press Res. 2018;43(3):793–806.

    Article  CAS  PubMed  Google Scholar 

  52. Brubaker AL, Stoltz DJ, Chaudhuri A, Maestretti L, Grimm PC, Concepcion W, et al. Superior hypertension management in pediatric kidney transplant patients after native nephrectomy. Transplantation. 2018;102(7):1172–8.

    Article  PubMed  PubMed Central  Google Scholar 

  53. Pickles C, Kaur A, Wallace D, Brix C, Lennon R, Plant N, et al. Bilateral native nephrectomies for severe hypertension in children with stage 5 chronic kidney disease leads to improved BP control following transplantation. Pediatr Nephrol. 2020.

  54. Varik RS, Taghizadeh A, Garriboli M, Patil K, Paul A, Clothier J, et al. Native nephrectomy in the management of hypertension in children with kidney disease: a tool to improve blood pressure control. Pediatr Surg Int. 2021.

  55. Yilmaz MI, Siriopol D, Saglam M, Kurt YG, Unal HU, Eyileten T, et al. Plasma endocan levels associate with inflammation, vascular abnormalities, cardiovascular events, and survival in chronic kidney disease. Kidney Int. 2014;86(6):1213–20.

    Article  CAS  PubMed  Google Scholar 

  56. de Souza LV, Oliveira V, Laurindo AO, Huarachı DG, Nogueira PCK, Feltran LD, et al. Serum Endocan Levels Associated with Hypertension and Loss of Renal Function in Pediatric Patients after Two Years from Renal Transplant. Int J Nephrol. 2016;2180765.

  57. Lendvai Z, Pásti K, Szeifert L, Molnár LD, Rusai K, Balassa K, et al. Cardiometabolic correlates of sleep-disordered breathing in renal transplant children. Pediatr Transplant. 2019;23(6):e13529.

    Article  PubMed  Google Scholar 

  58. Riva N, Schaiquevich P, Cáceres Guido P, Halac E, Dip M, Imventarza O. Pharmacoepidemiology of tacrolimus in pediatric liver transplantation. Pediatr Transplant. 2017;21(5).

  59. Riva N, Dip M, Halac E, Cáceres Guido P, Woillard JB, Licciardone N, et al. Survival time to biopsy-proven acute rejection and tacrolimus adverse drug reactions in pediatric liver transplantation. Ther Drug Monit. 2018;40(4):401–10.

    Article  CAS  PubMed  Google Scholar 

  60. Sgambat K, Clauss S, Lei KY, Song J, Rahaman SO, Lasota M, et al. Effects of obesity and metabolic syndrome on cardiovascular outcomes in pediatric kidney transplant recipients: a longitudinal study. Pediatr Nephrol. 2018;33(8):1419–28.

    Article  PubMed  Google Scholar 

  61. Hölttä T, Gordin D, Rahkonen O, Turanlahti M, Holmström M, Tainio J, et al. Good long-term renal graft survival and low incidence of cardiac pathology in adults after short dialysis period and renal transplantation in early childhood - a cohort study. Transpl Int. 2020;33(1):89–97.

    Article  PubMed  Google Scholar 

  62. Avendt MB, Taylor MD, Mitsnefes MM. Cardiac MRI assessment in children and young adults with end-stage renal disease. Clin Nephrol. 2018;90(3):172–9.

    Article  CAS  PubMed  Google Scholar 

  63. de Verteuil I, Fitzpatrick J, Elias ACA, Banh T, Vasilevska-Ristovska J, Browne J, et al. Longitudinal changes in cardiac structure and function in pediatric kidney transplant recipients. Hypertension. 2022;101161HYPERTENSIONAHA12117483.

  64. Sugianto RI, Memaran N, Schmidt BMW, Doyon A, Thurn-Valsassina D, Alpay H, et al. Findings from 4C-T Study demonstrate an increased cardiovascular burden in girls with end stage kidney disease and kidney transplantation. Kidney Int. 2022;101(3):585–96.

    Article  PubMed  Google Scholar 

  65. Choi AWM, Fong NC, Li VWY, Ho TW, Chan EYH, Ma ALT, et al. Left ventricular stiffness in paediatric patients with end-stage kidney disease. Pediatr Nephrol. 2020;35(6):1051–1060.

  66. Kasap Demir B, Soyaltin E, Alparslan C, Arslansoyu Çamlar S, Demircan T, Yavaşcan Ö, et al. Risk assessment for arrhythmia in pediatric renal transplant recipients. Exp Clin Transplant. 2021.

  67. Yılmaz S, Özçakar ZB, Taktak A, Kurt-Şükür ED, Çakar N, Yalçınkaya F. Proteinuria in pediatric renal transplant recipients. Pediatr Transplant. 2018;22(1).

  68. Perito ER, Phelps A, Vase T, Feldstein VA, Lustig RH, Rosenthal P. Subclinical atherosclerosis in pediatric liver transplant recipients: carotid and aorta intima-media thickness and their predictors. J Pediatr. 2018;193:119–127.e1.

    Article  PubMed  Google Scholar 

  69. Cammock C, Choudhry S, Castleberry CM, Al-Hammadi N, Eghtesady P, Canter CE, et al. Early stroke post-heart transplant is associated with decreased survival in children. J Heart Lung Transplant. 2018;37(6):733–9.

    Article  PubMed  Google Scholar 

  70. Kim JK, Lorenzo AJ, Raveendran L, Chua ME, Ming JM, Farhat WA, et al. Impact of native nephrectomy on hypertension outcomes in pediatric kidney transplant recipients: a 10-year institutional experience. Pediatr Surg Int. 2022.

  71. Sethna CB, Grossman LG, Dhanantwari P, Gurusinghe S, Laney N, Frank R, et al. Restoration of nocturnal blood pressure dip and reduction of nocturnal blood pressure with evening anti-hypertensive medication administration in pediatric kidney transplant recipients: a pilot randomized clinical trial. Pediatr Transplant. 2020;24(8):e13854.

    Article  CAS  PubMed  Google Scholar 

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  1. Schneider Children’s Medical Center of Israel, 14 Kaplan Street, 4920235, Petah Tikva, Israel

    Gilad Hamdani

  2. Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA

    Mark M. Mitsnefes

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  1. Gilad Hamdani
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Correspondence to Gilad Hamdani.

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Hamdani, G., Mitsnefes, M.M. Hypertension in Pediatric Solid Organ Transplant Recipients. Curr Hypertens Rep 25, 51–60 (2023). https://doi.org/10.1007/s11906-023-01237-5

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