Purpose: Pediatric lung transplant patients have been reported to have an increased incidence of hypertension. This incidence might be caused by the treatment with calcineurin inhibitors and steroids, which both might increase blood pressure (BP). In addition preexisting renal damage and renal calcineurin inhibitor toxicity might contribute to an increased cardiovascular risk. In order to characterize sequelae of hypertension we assessed vascular target organ damage in pediatric lung transplant recipients.

Methods: We have currently investigated 17 pediatric lung transplant recipients. Patients were 9-17 years old and had been transplanted 1-8 years ago. We assessed casual BP, aortal pulse wave velocity (PWV) and carotid intima-media thickness (IMT). In 16 patients, we also performed ambulatory BP measurements (ABPM). All values were normalized for age and expressed as SDS values.

Results: Two patients were hypertensive (> 95. percentile for gender, age, height) based on casual BP measurements at time of the investigation. Eleven patients received antihypertensive therapy using either Ca channel blocker, ß-blocker, ACE inhibitor or a combination therapy. Elevated BP despite treatment (i.e. uncontrolled hypertension) was confirmed in two additional patients by ABPM. Mean PWV was 0.2 ± 1.09 SDS adjusted for age; 1 patient showed PWV values elevated > 95. percentile. Mean IMT was 1.64 ± 1.00 SDS adjusted for age; 8 patients (47%) showed IMT values > 95. percentile.

Conclusion: The high incidence of hypertension in lung transplant recipients could be confirmed in our cohort. Almost half of the patients showed an increased IMT reflecting substantial atherosclerosis. As IMT is a predictor of future cardiovascular events, this finding reflects increased risk for cardiovascular events like myocardial infarction or stroke.

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