Introduction: Native nephrectomy in pediatric kidney transplant recipients is performed for congenital anomalies, proteinuria, intractable hypertension, malignancy, and chronic infection. Post-transplant hypertension requiring medical management is common, and the long-term impact of native nephrectomy on post-transplant hypertension, regardless of the indication, is poorly studied in large populations and is the purpose of this study.

Methods: 137 consecutive pediatric kidney transplant patients between 2007 and 2011 were retrospectively evaluated at a single center. Multiple organ (n=6) and re-transplanted (n=12) recipients were excluded from analysis. The remaining 119 patients were categorized into three groups: no nephrectomy (n=50), unilateral nephrectomy (n=34), and bilateral nephrectomy (n=35). The number of prescribed antihypertensive drugs and creatinine clearance were evaluated at 1, 3, and 5 years post-transplant. If and when patients developed graft failure (defined as a creatinine clearance < 20 mL/min per 1.73 m²), their corresponding hypertension data were excluded from analysis.

Results: Patients who underwent bilateral or unilateral nephrectomies had clinically significant improvement in post-transplant hypertension as measured by the mean number of prescribed antihypertensive medications when compared to patients with both native kidneys [bilateral vs. no nephrectomy: 1 year (p<0.0001), 3 years (p=0.0026), and 5 years (p=0.0005); unilateral vs. no nephrectomy: 1 year (p=0.0079), and 5 years (p=0.0121)]. Additionally, a significantly higher percentage of bilateral nephrectomy patients were observed to be completely off antihypertensive medications in comparison to patients with both native kidneys at 1 year (94.12% vs. 44%, p<0.0001), 3 years (83.87% vs. 55.56%, p=0.0127), and 5 years (86.67% vs. 52.17%, p=0.0057) post-transplant.

Conclusion: Pediatric kidney transplant recipients with bilateral native nephrectomies for any indication have superior long-term hypertension control. This is an essential consideration in operative planning where pediatric medication compliance can be a challenge and hypertension at a young age can have significant impact on cardiovascular health through a lifetime.

CITATION INFORMATION: Stoltz D, Brubaker A, Chaudhuri A, Grimm P, Concepcion W, Gallo A. Superior Long-Term Hypertension Management in Pediatric Kidney Transplant Recipients with Bilateral Native Nephrectomies. Am J Transplant. 2017;17 (suppl 3).

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