Management of infants and young children with combined heart and kidney failure

Area of Science:

• Pediatric Cardiology
• Nephrology
• Transplantation Medicine

Background:

• Infants and children needing cardiac transplants often present with low cardiac output, leading to kidney hypoperfusion, renal insufficiency, and failure.
• Combined heart and kidney failure is a critical concern in pediatric patients requiring cardiac transplantation.

Purpose of the Study:

• To review the literature and present single-center experience with combined heart and kidney failure in pediatric patients (<10 years) undergoing cardiac transplantation.
• To evaluate the necessity of combined heart and kidney transplantation versus heart transplantation alone in this population.

Main Methods:

• Literature review on combined heart and kidney failure in pediatric cardiac transplantation.
• Analysis of a single center's experience with pediatric patients (<10 years) undergoing cardiac transplantation.
• Assessment of pre- or peri-operative dialysis requirements and post-discharge/long-term follow-up of renal function.

Main Results:

• 39 infants (<10 years) received dialysis pre- or peri-operatively.
• None of the infants required dialysis support at discharge or during 5-10 year follow-up.
• Patients with primary heart disease and renal dysfunction undergoing heart transplant alone demonstrated recovery of renal function.

Conclusions:

• Heart transplantation alone may be sufficient for infants and young children with primary heart disease, even in the presence of renal dysfunction.
• Combined heart and kidney transplantation may not be necessary for all pediatric patients with concurrent renal issues.
• This approach can potentially avoid unnecessary procedures and improve outcomes in pediatric cardiac transplantation.