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Pediatr Nephrol (2004) 19:222226 DOI 10.1007/s00467-003-1317-8
ORIGINAL ARTICLE
Klaus Arbeiter Andrea Pichler Regina Stemberger Thomas Mueller Dagmar Ruffingshofer Regina Vargha Egon Balzar Christoph Aufricht
ACE inhibition in the treatment of children after renal transplantation
Received: 12 February 2003 / Revised: 9 July 2003 / Accepted: 14 August 2003 / Published online: 13 December 2003 IPNA 2003
Abstract Currently, there are no data available on long-term effects of angiotensin-converting enzyme inhibitors (ACE-I) on graft function in children after renal transplantation. We therefore analyzed all children who were transplanted at our institution between 1989 and 1998 and followed for at least 2 years. Those treated with ACE-I, mainly because of failure of other antihypertensive medications, were compared to those without ACE-I. The ACE-I-treated children (n=19) showed significantly better blood pressure control during the 1st year of follow-up (p<0.05). In children with chronic allograft dysfunction (n=8), treatment with ACE-I stabilized graft function, with improvement in creatinine clearance in 50% (p<0.01). Serum potassium and hemoglobin levels remained stable. One patient discontinued ACE-I because of renal artery stenosis. Taken together, ACE-I were effective and safe in the treatment of hypertension in children following renal transplantation. Children with chronic allograft dysfunction experienced a stabilizing effect on graft function.
Keywords ACE inhibitor Renal transplantation Children Hypertension Chronic allograft dysfunction
IntroductionIn pediatric renal transplantation, chronic rejection accounts for the majority of graft losses beyond the first
6 months [1]. Increasing evidence indicates such chronic graft dysfunction is multifactorial and that non-immuno-logic factors markedly contribute to this process [2]. The progressive decline in graft function is frequently associated with hypertension and proteinuria and is thus very reminiscent of the clinical course observed in many primary renal diseases. Similar to primary disease, reduction of blood pressure in adult transplant patients has been shown to stabilize renal allograft function [3].
Angiotensin-converting enzyme inhibitors (ACE-I) have been shown to interfere particularly well with the progressive deterioration of renal function in primary renal disease [4]. More recently, antiproteinuric and antihypertensive effects of ACE-I treatment were established in adults [5, 6, 7, 8]. To our knowledge, however, there are no such data available for the pediatric kidney recipients in the cyclosporine era [11].
The aim of this retrospective study was to report our experience on efficacy and safety of...