Chronic kidney disease in children following lung and heart–lung transplantation

Abstract

CKD is a major co-morbidity in pediatric lung transplant recipients. We report the prevalence of renal impairment post-lung transplant at a single center, using a modified, age-adjusted eGFR for the best approximation of true GFR, and investigated associations and possible predictors of decline in renal function post-transplant. Renal function was assessed by eGFR pre-transplant, three and 12 months post-transplant, and at last follow-up. Decline in renal function was analyzed as percentage fall in eGFR in two phases (0-3 and 3-12). Furthermore, we investigated impact of gender, age, pre-transplant diagnosis and renal function, transplant type, early post-transplant dialysis, and tacrolimus trough levels on decline in eGFR using multivariate analysis. Over a five-yr period, 30 transplants were performed. Mean eGFR pretransplant was 117 mL/min/1.73 m(2) (s.d. 35) with mean decline in eGFR during the first three months post-transplant of 33% (s.d. 31, p < 0.001). Thereafter, mean decline in eGFR was 8% (s.d. 18, p = 0.02). None of the factors assessed were significantly associated with decline in eGFR post-transplant. In conclusion, many children have decline in renal function following lung transplantation, particularly early post-transplant. Unlike in adults, we were unable to detect any predictors of renal impairment in pediatric lung transplant recipients.

Solid-Organ Transplantation in Childhood: Transitioning to Adult Health Care

“…Chronic kidney disease may occur after all pediatric solidorgan transplantation. [20][21][22][23] The etiology is multifactorial, can evolve before, during, or after the transplant, and compounds the development of other complications. Infectious disease is a major source of morbidity and mortality in all forms of pediatric solid-organ transplantation that may hinder timely transition.…”

Renal function assessment in child and adolescent heart transplant recipients during routine cardiac catheterization

“…Studies in adult heart transplant recipients have reported prevalence rates of CKD as high as 61–81% . In pediatric studies of heart transplant recipients, various methods have been used to assess kidney function in single‐center studies, resulting in a wider range of reported prevalence rates (7–67%) of CKD . The International Society for Heart and Lung Transplantation Sixteenth Official Pediatric Registry Report in 2013 reported that 5% of pediatric heart transplant recipients required renal replacement therapy by 11 yr after heart transplantation .…”

Overview of pediatric organ transplantation

“…Longitudinal growth provides a major contribution to patient QOL, as it is known that growth failure, pubertal delay, and short stature have considerable effects on self-esteem and psychosocial development [52,53]. Chronic kidney disease of multifactorial cause may occur after all pediatric solid-organ transplantation [54,55]. Infectious disease is a major source of morbidity and mortality in all forms of pediatric solid-organ transplantation [56,57].…”