Background:Cardiovascular disease results in increased morbidity and mortality in pediatric kidney transplant recipients. Longitudinal changes in cardiac structure and function and the association with blood pressure control over time in pediatric kidney transplant recipients are unknown.Methods:To determine the influence of blood pressure control on cardiac changes following pediatric kidney transplant, we conducted a retrospective cohort study of children who received their first kidney transplant at the Hospital for Sick Children from 2004 to 2015. Children were followed until transfer to adult care or censoring in July 2018. Cardiac structure and function parameters were collected from clinical echocardiograms and assessed using standardized scores. Blood pressure control was determined by systolic blood pressure Z scores (above or below the 90th percentile) in combination with antihypertensive medications. A segmented mixed-effects model assessed Z scores of interventricular septum thickness, left ventricular end-diastolic dimension, and left ventricular posterior wall dimension.Results:Of 142 children included, 58% were men, mean age at transplant was 11 (±4.5) years, and average follow-up time was 4 (±3) years. All cardiac structural Z scores improved during follow-up. Interventricular septum thickness normalized at 4.0 years post-transplant. Left ventricular end-diastolic dimension normalized at 1.5 years post-transplant. Left ventricular posterior wall dimension normalized at 6.3 years post-transplant. Left ventricular mass index showed sustained improvement up to 12 years post-transplant. Individuals with uncontrolled blood pressure had increased left ventricular mass (β=2.97 [95% CI, 0.77–5.16]).Conclusions:Cardiac structural abnormalities improve following kidney transplantation and normalize within 7 years, especially with controlled blood pressure. Strict blood pressure control is critical after pediatric kidney transplantation.

中文翻译：

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小儿肾移植受者心脏结构和功能的纵向变化

背景：心血管疾病导致儿童肾移植受者的发病率和死亡率增加。小儿肾移植受者心脏结构和功能的纵向变化以及随时间推移与血压控制的关系尚不清楚。方法：为了确定血压控制对小儿肾移植后心脏变化的影响，我们对儿童进行了一项回顾性队列研究他们于 2004 年至 2015 年在病童医院接受了第一次肾移植。对儿童进行随访，直到 2018 年 7 月转移到成人护理或审查。从临床超声心动图中收集心脏结构和功能参数，并使用标准化评分进行评估。血压控制由收缩压Z确定分数（高于或低于 90%）与抗高血压药物联合使用。分段混合效应模型评估了室间隔厚度、左心室舒张末期尺寸和左心室后壁尺寸的Z评分。结果：在包括的 142 名儿童中，58% 是男性，移植时的平均年龄为 11 岁 (±4.5)年，平均随访时间为 4（±3）年。所有心脏结构Z随访期间成绩有所提高。室间隔厚度在移植后 4.0 年恢复正常。左心室舒张末期尺寸在移植后 1.5 年正常化。移植后 6.3 年左心室后壁尺寸正常化。左心室质量指数显示持续改善至移植后 12 年。血压不受控制的个体左心室质量增加 (β=2.97 [95% CI, 0.77–5.16])。结论：心脏结构异常在肾移植后得到改善并在 7 年内恢复正常，尤其是在血压得到控制的情况下。小儿肾移植后严格控制血压至关重要。