End-stage renal disease after pediatric heart transplantation: A 25-year national cohort study

Choudhry, Swati; Dharnidharka, Vikas R.; Castleberry, Chesney; Goss, Charles W.; Simpson, Kathleen E.; Schechtman, Kenneth B.; Canter, Charles E.

doi:10.1016/j.healun.2017.09.027

Cited by 20 publications

(29 citation statements)

References 35 publications

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“…However, considering the controversy about the risks/benefits of BXM induction, the minimal effect of BXM decreasing the absolute risk of acute rejection reported by several authors 40 – 42 , together with the detrimental effect on Tregs shown in our study, cast doubt on the overall usefulness of BXM in pediatric heart transplantation. A recent large registry study employing multivariable models investigated the benefits of induction therapy in a cohort of pediatric heart transplanted patients after risk stratification 43 . Castleberry et al .…”

Section: Discussionmentioning

confidence: 99%

Basiliximab impairs regulatory T cell (TREG) function and could affect the short-term graft acceptance in children with heart transplantation

López‐Abente

Martínez‐Bonet

Bernaldo‐de‐Quirós

et al. 2021

Sci Rep

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CD25, the alpha chain of the IL-2 receptor, is expressed on activated effector T cells that mediate immune graft damage. Induction immunosuppression is commonly used in solid organ transplantation and can include antibodies blocking CD25. However, regulatory T cells (Tregs) also rely on CD25 for their proliferation, survival, and regulatory function. Therefore, CD25-blockade may compromise Treg protective role against rejection. We analysed in vitro the effect of basiliximab (BXM) on the viability, phenotype, proliferation and cytokine production of Treg cells. We also evaluated in vivo the effect of BXM on Treg in thymectomized heart transplant children receiving BXM in comparison to patients not receiving induction therapy. Our results show that BXM reduces Treg counts and function in vitro by affecting their proliferation, Foxp3 expression, and IL-10 secretion capacity. In pediatric heart-transplant patients, we observed decreased Treg counts and a diminished Treg/Teff ratio in BXM-treated patients up to 6-month after treatment, recovering baseline values at the end of the 12-month follow up period. These results reveal that the use of BXM could produce detrimental effects on Tregs, and support the evidence suggesting that BXM induction could impair the protective role of Tregs in the period of highest incidence of acute graft rejection.

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Section: Discussionmentioning

confidence: 99%

Basiliximab impairs regulatory T cell (TREG) function and could affect the short-term graft acceptance in children with heart transplantation

López‐Abente

Martínez‐Bonet

Bernaldo‐de‐Quirós

et al. 2021

Sci Rep

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“…Our finding that 3% of patients required dialysis in the first post‐transplant year is higher than those reported in earlier pediatric cohorts but lower than that reported by contemporary single‐center studies of broader HT populations . Linking the Scientific Registry of Transplant Recipients (SRTR) and United States Renal Data System datasets, Choudhry et al recently reported the need for dialysis occurred in 4% of pediatric heart transplant patients over an 11.8‐year follow‐up period and that having a history of VAD support was nearly twice as common in patients who did not require dialysis . Further study is required to better understand the risk factors for dialysis after HT in this population.…”

Section: Discussionmentioning

confidence: 99%

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

Hollander

Cantor

Sutherland

et al. 2019

Pediatric Transplantation

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Background The use of ventricular assist devices (VADs) in children with heart failure may be of particular benefit to those with accompanying renal failure, as improved renal function is seen in some, but not all recipients. We hypothesized that persistent renal dysfunction at 7 days and/or 1 month after VAD implantation would predict chronic kidney disease (CKD) 1 year after heart transplantation (HT). Methods Linkage analysis of all VAD patients enrolled in both the PEDIMACS and PHTS registries between 2012 and 2016. Persistent acute kidney injury (P‐AKI), defined as a serum creatinine ≥1.5× baseline, was assessed at post‐implant day 7. Estimated glomerular filtration rate (eGFR) was determined at implant, 30 days thereafter, and 12 months post‐HT. Pre‐implant eGFR, eGFR normalization (to ≥90 mL/min/1.73 m2), and P‐AKI were used to predict post‐HT CKD (eGFR <90 mL/min/1.73 m2). Results The mean implant eGFR was 85.4 ± 46.5 mL/min/1.73 m2. P‐AKI was present in 19/188 (10%). Mean eGFR at 1 month post‐VAD implant was 131.1 ± 62.1 mL/min/1.73 m2, significantly increased above baseline (P < 0.001). At 1 year post‐HT (n = 133), 60 (45%) had CKD. Lower pre‐implant eGFR was associated with post‐HT CKD (OR 0.99, CI: 0.97‐0.99, P = 0.005); P‐AKI was not (OR 0.96, CI: 0.3‐3.0, P = 0.9). Failure to normalize renal function 30 days after implant was highly associated with CKD at 1 year post‐transplant (OR 12.5, CI 2.8‐55, P = 0.003). Conclusions Renal function improves after VAD implantation. Lower pre‐implant eGFR and failure to normalize renal function during the support period are risk factors for CKD development after HT.

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“…ESKD was seen in 3% (n = 426) over a median follow‐up of 6.2 years. Choudhry et al 5 also looked at the SRTR and USRDS databases and reported that 4% heart transplant recipients developed ESKD over a median follow‐up of 11.8 years. The actuarial risk of developing ESRD 10 and 20 years post‐heart transplant was 3%, and 16%.…”

Section: Introductionmentioning

confidence: 99%

Acute kidney injury and chronic kidney disease after non‐kidney solid organ transplantation

Menon

Pollack

Sullivan

et al. 2020

Pediatric Transplantation

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Background SOT is the treatment of choice for end‐stage organ disease. Improved long‐term survival after NKSOT has uncovered chronic morbidity including CKD. AKI is common after NKSOT and may be associated with long‐term CKD. Methods We performed a retrospective cohort study looking at AKI and CKD after pediatric heart (n = 109) or liver (n = 112) transplant. AKI was defined using KDIGO creatinine‐based criteria. pAKI was AKI ≤ 7 days post‐transplant; CKD3‐5 was eGFR < 60 mL/min/1.73 m2 by modified Schwartz formula for > 3 months. We looked at the incidence of CKD3‐5 and the effect of perioperative pAKI on the slope of eGFR post‐transplant. Results pAKI was seen in 63% (n = 69) after heart and 38% (n = 43) after liver transplant. pAKI was associated with longer ICU and hospital stays. Cumulative incidence (95% CI) of CKD3‐5 at 60 months post‐heart transplant was 40.9% (27.9%‐57.1%) in patients with AKI vs 35.8% (17.1%‐64.8%) in those without (P = NS). Post‐liver transplant, the cumulative incidence of CKD3‐5 at 60 months was 0% in those without pAKI vs 10% (3.2%‐29.3%) in those with (P = .01). Patients with pAKI had lower eGFR at last follow‐up. Conclusion pAKI and CKD are common after NKSOT. Incidence of CKD is higher in those with pAKI. AKI episodes are associated with a drop in eGFR during follow‐up. Identifying patients who have had AKI is an important first step in identifying those at risk of repeated AKI episodes. These patients would benefit from closer monitoring for CKD, lower nephrotoxic drug use, and follow‐up with nephrology.

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End-stage renal disease after pediatric heart transplantation: A 25-year national cohort study

Abstract: ESRD after pediatric HTx is more prevalent in HTx survivors than documented by a transplant database alone. A number of factors develop at or after HTx that increase the risk for developing ESRD. Use of KTx in post-HTx ESRD is associated with improved survival.

Cited by 20 publications

References 35 publications

Basiliximab impairs regulatory T cell (TREG) function and could affect the short-term graft acceptance in children with heart transplantation

Basiliximab impairs regulatory T cell (TREG) function and could affect the short-term graft acceptance in children with heart transplantation

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

Acute kidney injury and chronic kidney disease after non‐kidney solid organ transplantation

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