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Updated: Jul 15, 2026
Robot-Assisted Kidney Transplantation
Published on: July 19, 2021
Pre-transplant risk factors for chronic renal dysfunction after pediatric heart transplantation: a 10-year national
Caroline K Lee1, Laura L Christensen, John C Magee
1Children's Hospital of the King's Daughters, Norfolk, Virginia , USA. caroline.lee@chkd.org [corrected]
Insights
Pediatric heart transplant recipients face increasing risks of chronic renal insufficiency and end-stage renal disease over time. Developing renal disease significantly elevates mortality risk in these young patients.
Area of Science:
- Pediatric Nephrology
- Cardiovascular Surgery
- Transplantation Medicine
Background:
- Chronic kidney disease is a known complication following pediatric heart transplantation (PHTx).
- Understanding the incidence and risk factors for renal dysfunction post-PHTx is crucial for improving patient outcomes.
Purpose of the Study:
- To determine the incidence of end-stage renal disease (ESRD) and chronic renal insufficiency (CRI) after PHTx.
- To identify pre-transplant patient characteristics associated with increased risk of ESRD and CRI.
- To evaluate the impact of renal disease on post-transplant survival.
Main Methods:
- Utilized data from the Scientific Registry of Transplant Recipients, CMS, and the Social Security Death Master File.
- Included pediatric PHTx recipients (age <18) surviving over 1 year in the USA (1990-1999).
- Employed Cox proportional hazards models to analyze risk factors and time-dependent Cox models for survival analysis.
Main Results:
- 3% of 2,032 PHTx recipients developed ESRD; 10-year risks were 4.3% for ESRD and 11.8% for CRI.
- Risk factors for ESRD included hypertrophic cardiomyopathy, African-American race, ICU stay/ECMO, and pre-transplant diabetes.
- Risk factors for CRI included pre-transplant dialysis, hypertrophic cardiomyopathy, African-American race, and prior transplant; CRI increased mortality risk ninefold.
Conclusions:
- Pediatric heart transplant recipients have a progressive risk of developing CRI and ESRD.
- Specific pre-transplant characteristics identify high-risk individuals for renal complications.
- Post-transplant renal disease is a significant independent predictor of mortality.
Background:
Chronic renal dysfunction may develop after pediatric heart transplantation (PHTx). We examined the incidence of end-stage renal disease (ESRD) and chronic renal insufficiency (CRI) after PHTx, the associated pre-transplant patient characteristics, and impact of renal disease on survival.
Methods:
Data sources included the Scientific Registry of Transplant Recipients, Centers for Medicare and Medicaid Services and the Social Security Death Master File. All PHTx recipients (age <18 years) in the USA from 1990 to 1999 who survived >1 year were included. ESRD was defined as long-term dialysis and/or kidney transplant. CRI was defined as creatinine >2.5 mg/dl, including those with ESRD. Relationships between pre-transplant characteristics and time to ESRD and CRI were analyzed using Cox proportional hazards models. The effect of renal disease on survival was analyzed using time-dependent Cox models.
Results:
During the mean follow-up of 7 years (range 1 to 14 years), 61 of 2,032 (3%) PHTxs developed ESRD. Ten-year actuarial risks for ESRD and CRI were 4.3% and 11.8%, respectively. In a multivariate analysis, significant risk factors for ESRD were: hypertrophic cardiomyopathy; African-American race; intensive care unit (ICU) stay or extracorporeal membrane oxygenation (ECMO) at time of transplant; and pre-transplant diabetes. Risk factors for CRI were: pre-transplant dialysis; hypertrophic cardiomyopathy; African-American race; and previous transplant. Adjusted risk of death in those who developed CRI was 9-fold higher than in those who did not (p < 0.0001).
Conclusions:
After PHTx there is an increasing risk for CRI and ESRD over time. Recipients with the characteristics identified in this study may be at greater risk. Development of renal disease significantly increases the risk of post-transplant mortality.
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