Longitudinal Follow-Up of Cardiovascular Comorbidity in Pediatric Renal Transplant Recipients - Results from the 4C-T Study

Longitudinal Follow-Up of Cardiovascular Comorbidity in Pediatric Renal Transplant Recipients – Results from the 4C-T Study

A. Melk,¹ D. Thurn-Valsassina,¹ B. Schmidt,¹ A. Duzova,² B. Soezeri,³ A. Bayazit,⁴ S. Caliskan,⁵ U. Querfeld,⁶ K. Ažukaitis,⁷ E. Wuehl,⁷ F. Schaefer.⁷

¹Hannover Medical School, Hannover, Germany
²Hacettepe University Medical Faculty, Ankara, Turkey
³Ege University Medical Faculty, Izmir, Turkey
⁴Cukurova University, Faculty of Medicine, Adana, Turkey
⁵Istanbul University Cerrahpasa Medial School, Istanbul, Turkey
⁶Charité
Universitätsmedizin Berlin, Berlin, Germany
⁷Centre for Pediatric and Adolescent Medicine, Heidelberg, Germany.

Meeting: 2015 American Transplant Congress

Abstract number: 129

Keywords: Kidney transplantation, Pediatric, Post-transplant hypertension, Vascular disease

Session Information

Session Name: Concurrent Session: Pediatric Kidney Transplantation

Session Type: Concurrent Session

Date: Sunday, May 3, 2015

Session Time: 4:00pm-5:30pm

Presentation Time: 4:48pm-5:00pm

Location: Room 119-A

Purpose: Children with chronic kidney disease (CKD) carry an increased cardiovascular risk. Cardiovascular death is the second leading cause of death in children after renal transplantation. The 4C-T (Cardiovascular Comorbidity in Children with CKD and Transplantation) study evaluates cardiovascular target organ damage longitudinally in children prior to and after renal transplantation.

Methods: 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 centres from 12 European countries. Of these, 226 have started renal replacement therapy (RRT) and entered the 4C-T sub-study. At annual study visits, the morphology and function of the heart and large arteries were monitored by noninvasive methods.

Results: 176 of the 226 patients on RRT had at least one visit after RRT start and were included in this analysis. 70 patients had started dialysis and 106 received a transplant. 62% of the patients were transplanted pre-emptively. Overall patients carried a higher cardiovascular risk compared to the agematched general population as documented by elevated age-adjusted aortic pulse wave velocity (PWV) and carotid intima-media thickness (IMT). Factors determining PWV, IMT and left ventricular mass index (LVMI) were analysed using mixed longitudinal modelling (table).

Conclusion: Our data is consistent with the hypothesis that transplantation lowers cardiovascular risk. Mixed modeling allowed to decipher the positive effect of transplantation from interfering cardiovascular risk factors such as hypertension, hypercholesterolemia and PTH.

Mixed longitudinal model for PWV, IMT and LVMI
	PWV		IMT		LVMI
Effect	Estimate	p	Estimate	p	Estimate	p
Dialysis	0.4648	0.0024	0.2793	0.0448	4.1835	0.0068
Tx after dialysis	0.3980	0.0264	-0.00253	0.9876	3.9145	0.0283
preemptive Tx	Reference		Reference		Reference
BP	0.04065	<0.0001	0.01427	0.0212	0.1167	0.0054
PTH	0.009556	<0.0001	0.003614	0.074	0.07823	0.0003
male gender	-0.4157	0.0019	-0.3076	0.0135	3.5783	0.0089

To cite this abstract in AMA style:

Melk A, Thurn-Valsassina D, Schmidt B, Duzova A, Soezeri B, Bayazit A, Caliskan S, Querfeld U, Ažukaitis K, Wuehl E, Schaefer F. Longitudinal Follow-Up of Cardiovascular Comorbidity in Pediatric Renal Transplant Recipients – Results from the 4C-T Study [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/longitudinal-follow-up-of-cardiovascular-comorbidity-in-pediatric-renal-transplant-recipients-results-from-the-4c-t-study/. Accessed May 19, 2025.

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