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).

• Keywords
• Children, Cyclosporine, Hypertension, Immunosuppression, Kidney transplantation, Sex differences,
• MeSH
• Time Factors MeSH
• Cyclosporine administration & dosage   adverse effects   pharmacokinetics   MeSH
• Child MeSH
• Hypertension diagnosis   epidemiology   etiology   MeSH
• Immunosuppressive Agents administration & dosage   adverse effects   pharmacokinetics   MeSH
• Humans MeSH
• Longitudinal Studies MeSH
• Blood Pressure Determination statistics & numerical data   MeSH
• Adolescent MeSH
• Follow-Up Studies MeSH
• Child, Preschool MeSH
• Prevalence MeSH
• Transplant Recipients statistics & numerical data   MeSH
• Registries statistics & numerical data   MeSH
• Graft Rejection immunology   prevention & control   MeSH
• Retrospective Studies MeSH
• Sex Factors MeSH
• Tacrolimus administration & dosage   adverse effects   pharmacokinetics   MeSH
• Kidney Transplantation adverse effects   MeSH
• Age Factors MeSH
• Check Tag
• Child MeSH
• Humans MeSH
• Adolescent MeSH
• Male MeSH
• Child, Preschool MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH
• Geographicals
• Europe epidemiology   MeSH
• Names of Substances
• Cyclosporine MeSH
• Immunosuppressive Agents MeSH
• Tacrolimus MeSH