Children with chronic kidney disease (CKD) carry an increased cardiovascular risk up to 1000-fold that of the age-matched general population. The 4C-T (Cardiovascular Comorbidity in Children with CKD after Transplantation) study is a sub-study of the 4C study (www.4c-study.org) and evaluates cardiovascular
target organ damage longitudinally in children prior to and after transplantation. The major hypotheses of the 4C-T study are: 1) The progression of cardiovascular target organ damage is reduced or even reversed by renal transplantation. 2) Children undergoing preemptive transplantation have less long-term cardiovascular target organ damage.
The multicenter, prospective, observational 4C study enrolled 736 children aged 6 to 17 years with estimated GFR < 40 ml/min/1.73 m2 at 55 Pediatric Nephrology centers from 12 European countries. Of these, 591 have been followed for at least one year to date. At the annual study visits, the morphology and function of the heart and large arteries was monitored by noninvasive methods and compared to aged-matched healthy controls.
During the observation time, 130 patients started renal replacement therapy (76 dialysis, 54 transplantation) and entered the 4C-T sub-study. The majority of patients (63 %) was transplanted preemptively. Almost all patients carried a higher cardiovascular risk compared to the age-matched general population as documented by elevated mean age-adjusted aortic pulse wave velocity (PWV) and carotid intima-media thickness (IMT). Transplanted patients displayed significantly lower PWV and left ventricular mass index (LVMI) compared to patients on dialysis (fig. A, C), whereas no difference was seen for IMT (fig. B).
Our preliminary analyses suggest an improved cardiovascular risk profile in patients undergoing early transplantation. With more and more patients becoming eligible for the 4C-T study, this study is uniquely suited to answer questions with regard to prevalence, degree, and progression of cardiovascular comorbidity after transplantation.
To cite this abstract in AMA style:Melk A, Kracht D, Doyon A, Zeller R, Litwin M, Duzowa A, Sözeri B, Bayzit A, Caliskan S, Wuehl E, Schaefer F, Schmidt B. Cardiovascular Risk Profile in Children after Renal Transplantation – Introducing the 4C-T Sub-Study [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/cardiovascular-risk-profile-in-children-after-renal-transplantation-introducing-the-4c-t-sub-study/. Accessed July 30, 2021.
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