Impact of native nephrectomy on hypertension outcomes in pediatric kidney transplant recipients: a 10-year institutional experience

Abstract

Objective: To assess the role native nephrectomy (NN) in hypertension-related outcomes for pediatric patients undergoing renal transplantation (RT).

Methods: Renal transplants (RT) performed at our institution between 2006 and 2015 were reviewed. RT recipients who underwent NN were compared to those who did not. Primary outcomes were hypertension-related: use/number of medications pre-/post-transplant and hypertension-related readmissions. Secondary outcomes were 1-year outcomes of: readmissions, eGFR, Clavien-Dindo classification ≥ 3 complications, and graft loss.

Results: 135 patients were evaluated. 24 underwent NN (Group 1) and 111 did not (Group 2). Baseline characteristics were similar between Groups 1 and 2. The majority of NN indications were hypertension (10/39 kidneys) and proteinuria (12/39 kidneys). There were no differences in use/number of anti-hypertensive medications pre- or post-transplant. However, between Group 2 and subgroup of patients who underwent NN for hypertension, a significant difference was seen in medication use/numbers but not post-transplant. Number of readmissions due to hypertension was similar (7.2% vs. 12.5%). The only difference in secondary outcomes was higher readmission rates with bacterial infections for group 1 (45.8% vs. 23.4%, p = 0.041).

Conclusion: NN, when offered to patients at higher risk of post-RT hypertension, may allow high-risk patients to achieve similar hypertension outcomes as those at lower risk.

Keywords: Hypertension; Kidney transplant; Native nephrectomy; Pediatric.