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Determinants of renal function in pediatric heart transplant recipients: long-term follow-up study
Ritu Sachdeva1, Richard T Blaszak, Kathryn A Ainley
1Division of Pediatric Cardiology, Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Little Rock, Arkansas 72202, USA. sachdevaritu@uams.edu
Insights
Renal insufficiency (RI) is common in pediatric heart transplant patients, increasing over time. African-American race, younger age, longer wait times, and calcineurin inhibitors are key risk factors for developing RI.
Area of Science:
- Pediatric Cardiology
- Nephrology
- Transplantation Medicine
Background:
- Renal insufficiency (RI) is a recognized complication following heart transplantation.
- Understanding RI prevalence and risk factors in pediatric heart transplant recipients is crucial for long-term outcomes.
Purpose of the Study:
- To determine the prevalence of renal insufficiency in pediatric heart transplant recipients.
- To identify significant risk factors associated with the development of renal insufficiency in this population.
Main Methods:
- A cohort of 77 pediatric heart transplant recipients with at least 1 year of follow-up was analyzed.
- Data collected included pre-transplant factors and post-transplant assessments up to 5 years.
- Evaluated factors included demographics, cardiac diagnosis, support devices, rejection, and calcineurin inhibitor use.
Main Results:
- RI prevalence was 33% pre-transplant, rising to 25.9% by 5 years post-transplant.
- Significant risk factors identified were African-American race, younger age at transplant, longer listing duration, and calcineurin inhibitor levels.
- RI at 6 months post-transplant predicted chronic kidney disease at 5 years (OR=9).
Conclusions:
- Renal insufficiency prevalence increases over a 5-year follow-up in pediatric heart transplant patients.
- Key determinants of RI include race, age at transplant, listing duration, calcineurin inhibitor levels, and early post-transplant renal function.
- Close monitoring and early nephrology referral are recommended for pediatric heart transplant recipients at risk for chronic kidney disease.
Background:
Renal insufficiency (RI) is a known complication in heart transplant recipients. We sought to determine the prevalence and risk factors for RI in pediatric heart transplant recipients over a long-term follow-up period.
Methods:
The study cohort included 77 pediatric heart transplant recipients (35 girls, 18 African Americans) who had a minimum follow-up of 1 year. Data were obtained from pre-transplant evaluations and at 1, 6 and 12 months post-transplant and annually thereafter. Factors evaluated for their influence on renal function included duration of listing, age at transplant, gender, race, cardiac diagnosis, use of assist devices, inotropic support, rejection episodes and use of calcineurin inhibitors.
Results:
The median age at transplant was 2 years, with a median follow-up duration of 5.1 years. RI was prevalent in 33% pre-transplant, and in 17%, 21% and 25.9% at 1, 3 and 5 years post-transplant, respectively. Two patients developed end-stage renal disease requiring long-term dialysis, with 1 eventually receiving a renal transplant. Significant risk factors for RI were African-American race (p = 0.04), younger age at transplant (p = 0.007), duration of listing (p < 0.0001) and calcineurin inhibitor level (p = 0.003). RI at 6 months post-transplant predicted chronic kidney disease at 5 years (odds ratio = 9).
Conclusions:
The prevalence of RI increased during a median follow-up of 5 years in this pediatric heart transplant cohort. African-American race, younger age at transplant, longer duration of listing, high level of calcineurin inhibitors and RI at 6 months were important determinants of RI. These patients should be followed-up carefully with early referral to a pediatric nephrologist if they develop chronic kidney disease.
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