BACKGROUND: High prevalence of arterial hypertension is known in pediatric renal transplant patients, but how blood pressure (BP) distribution and control differ between age groups and whether sex and age interact and potentially impact BP after transplantation have not been investigated. METHODS: This retrospective analysis included 336 pediatric renal transplant recipients (62% males) from the Cooperative European Pediatric Renal Transplant Initiative Registry (CERTAIN) with complete BP measurement at discharge and 1, 2 and 3 years post-transplant. RESULTS: At discharge and 3 years post-transplant, arterial hypertension was highly prevalent (84% and 77%); antihypertensive drugs were used in 73% and 68% of the patients. 27% suffered from uncontrolled and 9% from untreated hypertension at 3 years post-transplant. Children transplanted at age < 5 years showed sustained high systolic BP z-score and received consistently less antihypertensive treatment over time. Younger age, shorter time since transplantation, male sex, higher body mass index (BMI), high cyclosporine A (CSA) trough levels, and a primary renal disease other than congenital anomalies of the kidney and urinary tract (CAKUT) were significantly associated with higher systolic BP z-score. Sex-stratified analysis revealed a significant association between high CSA and higher systolic BP in older girls that likely had started puberty already. An association between BP and estimated glomerular filtration rate was not detected. CONCLUSIONS: BP control during the first 3 years was poor in this large European cohort. The description of age- and sex-specific risk profiles identified certain recipient groups that may benefit from more frequent BP monitoring (i.e. young children) or different choices of immunosuppression (i.e. older girls).

Center for Children and Adolescent Pediatric Clinic 2 University of Duisburg Essen Essen Germany

Department of General Pediatrics Adolescent Medicine and Neonatology Faculty of Medicine University of Freiburg Freiburg Germany

Department of General Pediatrics University Hospital Muenster Muenster Germany

Department of General Pediatrics University of Tuebingen Tuebingen Germany

Department of Nephrology Hannover Medical School Hannover Germany

Department of Pediatric Kidney Liver and Metabolic Diseases Hannover Medical School Carl Neuberg Str 1 30625 Hannover Germany

Department of Pediatric Nephrology Izmir Tepecik Teaching and Research Hospital Izmir Turkey

Department of Pediatrics 1 University Children's Hospital Heidelberg Heidelberg Germany

Department of Pediatrics 2nd Faculty of Medicine Charles University Prague Czech Republic

Division of Pediatric Nephrology and Transplantation University Medical Center Hamburg Eppendorf Hamburg Germany

Division of Pediatric Nephrology Faculty of Medicine Ankara University Ankara Turkey

Division of Pediatric Nephrology Faculty of Medicine Hacettepe University Ankara Turkey

Division of Pediatric Nephrology Faculty of Medicine Ondokuz Mayis University Samsun Turkey

KfH Kidney Centre for Children and Adolescents St Georg Hospital Leipzig Germany

KfH Kidney Centre for Children and Adolescents University Hospital Giessen Marburg Marburg Germany

Olga Children's Hospital Clinic of Stuttgart Stuttgart Germany

Pediatric Nephrology Dialysis and Transplant Unit Hospital University Padua Padua Italy

Renal Transplant Clinic Bambino Gesu Children's Hospital IRCCS Rome Italy

Royal Manchester Hospital Manchester UK

The Children's Memorial Health Institute Warsaw Poland

University Children's Hospital Rostock Rostock Germany

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