Changes in renal function after left ventricular assist device placement in pediatric patients: A Pedimacs analysis

Renal injury and recovery in pediatric patients after ventricular assist device implantation and cardiac transplant

“…The results of this study corroborate prior studies that demonstrate renal recovery is an important prognostic indicator of post‐operative renal function in both adults and children undergoing cardiac surgery, including transplantation. In particular, our study builds upon the findings of Friedland‐Little et al, who, using a similar cohort, demonstrated that failure to normalize renal function early after VAD implantation is a risk factor for sustained renal dysfunction during the MCS period . The present study now shows that renal injury that does not improve with VAD support predicts long‐term CKD which is likely to persist after transplantation.…”

“…Recently, May et al reported that renal function improved after VAD implantation in pediatric patients with pre‐existing renal disease . Using the Pediatric Interagency Registry for Mechanically Assisted Circulatory Support (PEDIMACS), Friedland‐Little et al reported that renal dysfunction was present in 61% of pediatric VAD patients and that failure to normalize renal function 1 week after implantation correlated with persistent renal dysfunction at 1 month . Neither of these studies, however, examined how changes in renal function during the support period affect post‐transplant outcomes.…”

“…10 Using the Pediatric Interagency Registry for Mechanically Assisted Circulatory Support (PEDIMACS), Friedland-Little et al reported that renal dysfunction was present in 61% of pediatric VAD patients and that failure to normalize renal function 1 week after implantation correlated with persistent renal dysfunction at 1 month. 11 Neither of these studies, however, examined how changes in renal function during the support period affect posttransplant outcomes. In adults, Singh et al reported that the use of mechanical circulatory support (MCS) improved renal function in those awaiting HT, and furthermore, that post-transplant renal outcomes were highly dependent on the level of renal recovery achieved after initiation of MCS.…”

ISHLT consensus statement for the selection and management of pediatric and congenital heart disease patients on ventricular assist devices Endorsed by the American Heart Association

“…There is evidence that end-organ dysfunction in children can improve significantly with a paracorporeal CF device and this may have a beneficial effect on outcomes. 16,17,18 ECMO support prior to VAD implantation has not been associated with better survival post VAD, 8,12 although it is difficult to separate the impact of ECMO from the level of illness requiring ECMO in interpreting this data.…”

“…End-organ dysfunction is common in pediatric VAD patients prior to implantation, with 45% of patients intubated (paracorporeal devices 75-85% of patients compared to intracorporeal devices 21%), 94% on inotropes, 64% requiring feeding tubes/TPN, 40% with hyperbilirubinemia and 30% having a glomerular filtration rate (GFR) < 60 mL minÀ1 1.73 m. 2,12 These findings are notable given end-organ dysfunction is associated with poor outcomes among VAD patients and following transplantation 3,7,14,18 and timely implantation can result in reversal of end-organ dysfunction and better outcomes. 16,19 Post-cardiotomy failure to wean from cardiopulmonary bypass (CPB): The presence of a previous sternotomy or additional cardiac surgery in pediatric VAD patients ranges from 23% to 39%. 12,20 Post-cardiotomy patients (in most circumstances those with CHD), who fail to wean from cardiopulmonary bypass (CPB) are more likely to be converted to ECMO or implanted with paracorporeal CF devices.…”