*Purpose: End-stage renal disease is often accompanied by cardiovascular events, and cardiovascular events still exist after kidney transplantation. Cardiovascular disease is the main cause of death in pediatric renal transplant recipients. Our study aims to assess the cardiovascular risk after kidney transplantation in children and adolescents.

*Methods: Cardiovascular assessment of 46 patients under the age of 18 who underwent allogeneic kidney transplantation in the First Affiliated Hospital of Sun Yat-sen University, including clinical assessment, ambulatory blood pressure (ABPM), carotid ultrasound, electrocardiogram, echocardiogram, cardiopulmonary Exercise test. Among them, echocardiography uses tissue Doppler, speckle tracking technology and Tei index to assess heart function.

*Results: Among the 46 pediatric renal transplant recipients, 34 were hereditary nephropathy and 12 were non-hereditary nephropathy. The average age of kidney transplantation was 9.8 years. The average estimated time from kidney transplantation was 11.07 months, and the average dialysis time before transplantation was 8.31 months. The intima thickness (cIMT) of the right carotid artery was 0.62+/-0.09cm, which was increased compared with the previously reported cIMT of normal children. The left ventricular myocardium was thickened in 9 patients, and the left ventricle was enlarged in 5 patients; the echo of the aortic valve was enhanced in 18 patients, and the echo of the aortic wall was enhanced in 4 patients. The EF values of all patients were in the normal range, but the decrease of the left ventricular longitudinal strain value (LV GLS) in 36 patients indicated abnormal left ventricular systolic function; 9 patients had abnormal left ventricular diastolic dysfunction; 4 patients had abnormal right ventricular function. Among them, the LV GLS of the patients after kidney transplantation was -17.18%±3.58%, the right ventricular longitudinal strain value (RV GLS) was -20.9%±5.13%, and the Tei index was 0.52±0.08. 10 patients who cooperated to complete the non-invasive cardiac output examination All indicate decreased exercise tolerance, and the maximum oxygen intake/predicted value after exercise is less than 85%. According to statistical analysis, LVMI is correlated with NT-proBNP and CysC (P<0.05),cIMT is correlated with Ca (P<0.05).

*Conclusions: Most pediatric renal transplant recipients have cardiovascular disease. Patients after kidney transplantation need to be regularly monitored for cardiovascular disease. Early detection of cardiovascular disease and appropriate intervention can improve the cardiovascular prognosis of kidney transplant patients.

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