Purpose: Early life stress (ELS) has emerged as an important cardiovascular risk factor in adulthood, and can be characterized by exposure to adverse childhood experiences (ACE). The effect of ELS on future cardio-renal outcomes in kidney transplant recipients is unknown. We hypothesized that increased childhood adversity correlates with biomarkers of future cardio-renal risk in kidney transplant recipients.

Methods: Interim analysis of 14 subjects from an ongoing cohort study of ELS exposure in 80 adolescent and young adult kidney transplant recipients. ELS was quantified using the ACE questionnaire, which measures ACE exposures in domains of abuse, neglect, and household dysfunction. We modeled ACE as a binary exposure (present vs. absent) and a categorical exposure (ACE=0, 1, ≥ 2). Cardiovascular outcomes included pulse wave velocity (PWV) and left ventricular (LV) mass. Renal outcomes included early subclinical acute rejection assessed by surveillance biopsies performed at 3 and/or 6 months post-transplant with normal/stable graft function. We compared clinical, demographic, cardiovascular and renal variables across binary and categorical ACE exposure groups.

Results: The cohort had a mean age of 17 ± 0.5 years, transplant vintage of 32 ± 5 months, and estimated GFR of 75 ± 6 mL/min/1.73 m². ACE exposures were reported as > 0 in 10/14 (71%) subjects. Of those with ACE > 0, there were 7 (50%) with ACE=1 and 3 (21%) with ACE ≥ 2. All ACE groups had similar baseline clinical and demographic data, including race, sex, estimated GFR and blood pressure. Overall, mean raw PWV was 6.7 ± 2.0 m/s, mean PWV Z-score was 1.5 ± 2.0, and mean LV mass was 49 ± 8 g/m^2.7. Raw PWV and PWV Z-scores were similar across binary and categorical ACE exposure groups. We observed a trend for greater LV mass in those with ACE > 0 (52 ± 3 vs. 44 ± 4 in ACE=0; P=0.10). There was significantly more subclinical acute rejection in those with ACE > 0 (67% in ACE ≥ 2 vs. 80% in ACE=1 vs. 0% in ACE=0; P<0.05).

Conclusions: In spite of the small study population in this interim analysis, we detected similar rates of ELS exposure in adolescent and young adult kidney recipients compared to reports in the general population. ELS exposure was associated with a trend for increased LV mass and significantly more subclinical rejection. The preliminary association of ELS exposure with adverse cardio-renal outcomes will be further explored in the entire cohort.

CITATION INFORMATION: Seifert M., Perry P., Romp R., Mannon R., Pollock J. Early Life Stress Exposure and Cardio-Renal Outcomes in Pediatric Kidney Transplantation Am J Transplant. 2017;17 (suppl 3).

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