Longitudinal renal function in pediatric heart transplant recipients: 20‐years experience

Abstract

This study was initiated to assess the temporal trends of renal function, and define risk factors associated with worsening renal function in pediatric heart transplant recipients in the immediate post-operative period. We performed a single-center retrospective study in children ≤18 yr receiving OHT (1993-2012). The AKIN's validated, three-tiered AKI staging system was used to categorize the degree of WRF. One hundred sixty-four patients qualified for inclusion. Forty-seven patients (28%) were classified as having WRF after OHT. Nineteen patients (11%) required dialysis after heart transplantation. There was a sustained and steady improvement in renal function in children following heart transplantation in all age groups, irrespective of underlying disease process. The significant factors associated with risk of WRF included body surface area (OR: 1.89 for 0.5 unit increase, 95% CI: 1.29-2.76, p = 0.001) and use of ECMO prior to and/or after heart transplantation (OR: 3.50, 95% CI: 1.51-8.13, p = 0.004). Use of VAD prior to heart transplantation was not associated with WRF (OR: 0.50, 95% CI: 0.17-1.51, p = 0.22). On the basis of these data, we demonstrate that worsening renal function improves early after orthotopic heart transplantation.

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

“…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 .…”

“…In our study, these patients were older and more likely to be male. Three percent of patients in this study required dialysis at some point in the first post‐transplant year, mostly in the first 30 post‐operative days, which is less frequent than that reported for adults or the pediatric heart failure population in general . Lower pre‐implant eGFR was associated with post‐transplant CKD.…”

“…Three percent of patients in this study required dialysis at some point in the first post-transplant year, mostly in the first 30 post-operative days, which is less frequent than that reported for adults or the pediatric heart failure population in general. 19,20 Lower pre-implant eGFR was associated the support phase in adults awaiting heart transplantation and that patients who achieved an eGFR of at least 60 mL/min during the MCS period had similar post-transplant renal function regardless of eGFR before VAD implantation. 12,21,22 These data support the idea that the etiology of renal dysfunction in pediatric heart failure is likely multifactorial, with a circulatory component driven by poor renal perfusion coupled with the presence of intraparenchymal kidney injury.…”

“…[26][27][28][29] 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 singlecenter studies of broader HT populations. 19 rather than daily in the first post-operative week, the true incidence of AKI as defined by the KDIGO criteria could not be ascertained.…”

A novel acute kidney injury scoring system for renal and clinical outcomes in pediatric heart transplant patients

“…Acute kidney injury (AKI) in children is associated with increased length of stay (LOS), re‐hospitalization, mortality, and the development of chronic kidney disease (CKD) 1–7 . In the pediatric heart transplant (HT) population, persistent AKI has been associated with an increased risk of CKD within the first year after the transplant 8–10 .…”