Hypertension is a common problem after renal transplantation. We investigated potential contributing factors for high blood pressure (BP) in 336 pediatric transplant recipients from the CERTAIN registry. Data at discharge, 1, 2, and 3 years (yrs) post-transplant included clinical and laboratory parameters, as well as antihypertensive and immunosuppressive medication. Underlying diseases were grouped as CAKUT (congenital anomalies of the kidney and urinary tract) and NON-CAKUT. Use of calcineurin inhibitors (CNI) was classified by trough level (TL): high cyclosporine (CsA) TL (≥120 [micro]g/L), low CsA TL <120 [micro]g/L), high tacrolimus (Tac) TL (≥7 [micro]g/L), low Tac TL (<7 [micro]g/L) and no CNI. Patients were grouped as pre-pubertal (girls<8yrs; boys<9.7yrs) or pubertal (girls≥8yrs; boys≥9.7yrs).

In the mixed model analysis, male sex (P<.018), higher BMI (P<.001), higher CsA TL (P<.001), NON-CAKUT (P<.001) and being pre-pubertal (P<.001) were associated with higher systolic BP. Stratification by puberty revealed higher CsA TL (P=.024), higher Tac TL (P=.043) and NON-CAKUT to be significantly associated with higher BP in pre-pubertal children. The model for pubertal children showed male sex (P=.011), younger age (P<.001), BMI (P<.001), CsA TL (P=.003) and NON-CAKUT (P=.006) associated with higher BP. Because of the sex difference in pubertal children, we then stratified by sex (Fig. shows corrected means based on immunosuppressive TL). In pubertal children younger age (girls P=.004; boys P<.001) and BMI (girls P=.02; boys P<.001) were correlated with higher BP. The association between higher CsA TL (P=.003) with higher BP could only be seen in girls.

Multiple factors were associated with higher BP: male sex, higher BMI, younger age and NON-CAKUT as underlying disease. The interesting finding of a differential effect of CsA was only discovered after stratification for puberty. The association of higher CsA TL on BP in pubertal girls suggests a potential protective role of male sex hormones.

CITATION INFORMATION: Melk A, Sugianto R, Schmidt B, Krupka K, Höcker B, Tönshoff B, Wühl E. Cyclosporine Effects on Blood Pressure Are Exaggerated in Pubertal Girls After Renal Transplantation. Am J Transplant. 2017;17 (suppl 3).

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