491 - Cardiovascular Outcomes in Pediatric Kidney Transplant Recipients

Publication Number: 2477.491

Shirley Pollack, Rambam Health Care Center, Haifa, HaZafon, Israel; Moran Plonsky Toder, Rambam Health Care Campus, Haifa, Hefa, Israel; Daniella Magen, Rambam Health Care Campus, Technion Faculty of Medicine, Haifa, Hefa, Israel

Background: Chronic kidney disease (CKD) is a well-established risk factor for cardiovascular (CV) morbidity and mortality. Left ventricular hypertrophy (LVH) is highly prevalent among dialysis patients, affecting 85% of hemodialysis patients. While CV risk factors are well-studied in adult CKD and transplant populations, pediatric data remain limited.

Objective: To identify risk factors associated with adverse cardiovascular outcomes in pediatric renal transplant recipients.

Design/Methods: We retrospectively analyzed CV outcomes in 72 pediatric renal transplant recipients (PRTR) treated between 2014–2024 at a tertiary center. Follow-up ranged from 1 to 12 years. Variables included sex, dialysis modality and duration, age at transplantation, donor type (living vs. deceased), induction therapy (Basiliximab vs. Thymoglobulin), and need for immunosuppression intensification following rejection episodes. We have also collected data regarding traditional CV risks including dyslipidemia, diabetes mellitus (DM) and impaired glucose tolerance (IGT).

Results: The cohort (72 patients) included 37% females; median age 12 years (range 3–18). CKD etiology was immunologic in 21% and congenital/genetic in 79%. Living donors accounted for 40%. Basiliximab with high-dose steroids was used in 94.5%; Thymoglobulin in 5.5%. Immunosuppression intensification occurred in 37.5%. CV outcomes included hypertension (41.6%), LVH (7%), aortic root enlargement (4%), reduced ejection fraction (1.3%), post-transplant DM (7%), IGT (3%), and dyslipidemia (1.4%). Binary logistic regression revealed a significant interaction between donor type and immunosuppression intensification on CV risk (OR = 9.9, 95% CI 1.03–95.6, p = 0.047). Intensified immunosuppression significantly increased CV risk in deceased donor recipients (DDR), while donor type had minimal impact in those not requiring intensification. Dialysis method and duration were not statistically associated with CVD nor the other variables tested (table 1).

Conclusion(s): In PRTR, intensified immunosuppression following DDR was a significant risk factor for adverse CV outcomes. This finding underscores the need for vigilant CV monitoring in patients with high immunologic risk. The absence of associations with other variables may reflect the longer latency of CV disease in children. Tailored surveillance strategies and multicenter studies with extended follow-up are needed to refine pediatric CV risk stratification post-transplant.

cardiovascular disease risk association
Table 1.pdf