Kis Éva, Cseprekál Orsolya, Pászka Dóra, Katona Gábor, Horváth Zsófia, Szabó J Attila, Fekete Bertalan Csaba, Reusz György S Semmelweis University, 1st Department of Pediatrics, Budapest

Background: Cardiovascular disease is the leading cause of death among patients with end-stage renal disease (ESRD). Transplantation increases life expectations of patients with ESRD, however there is still an increased risk of accelerated arteriosclerosis. As an early marker of increased arterial stiffness pulse wave velocity (PWV) is a non-invasive indicator of arteriosclerosis.

Aim: to evaluate PWV values of transplanted (Tx) children

Patients, Methods: PWV was measured with PulsePen in 25 Tx children (age 15,1+3,8 years). Two control groups were formed using a database of 133 healthy children (6-23 years): one matched for age (A) and one adjusted for height and weight (H/W). Blood pressure, heart rate, serum Calcium (Ca), Phosphate (P), and PTH were also determined before transplantation and at the time of the PWV measurement.

Results: Tx patients were smaller than A (148,8+15,5 vs. 163,1+15,1cms, p<0,05) and younger (15,1+3,8 vs 12,2+3,2years, p<0,01) than H/W. PWV in Tx (5,5+0,7 m/s) did not differ significantly from A (5,1+0,9) , however it was elevated in comparison to H/W (4,6+0,8 p<0,01). Serum P, CaxP and PTH was increased before transplantation, all the values returned into the normal range except for creatinine (106+50 micromol/l) at the time of the study. PWV correlated with plasma level of FK506 (r:0,46, p<0,05) but there was no correlation between PWV and the actual values of Ca, P and PTH.

Conclusion: PWV is higher in transplanted children as a sign of increased arterial stiffness. Controls matched for height and weight should be used in states of severe growth failure. Although a number of established risk factors potentially responsible for arterial dysfunction were present before transplantation, they were normal at the time of the study. The long lasting effect of uremia before and the immunsupressive therapy after transplantation could be in part responsible for the increased PWV in Tx children.

Supported OTKA-T046155-F048842-F042563 and ETT 435/2006