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Renal transplantation after previous pediatric heart transplantation
Jyoti Gupta1, Sandra Amaral, William T Mahle
1Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia 30322, USA.
Insights
Renal transplantation after pediatric heart transplantation shows favorable intermediate-term survival. This kidney transplant strategy is effective for patients with calcineurin inhibitor-induced nephrotoxicity.
Area of Science:
- Cardiology
- Nephrology
- Transplantation Immunology
Background:
- Calcineurin inhibitor-induced nephrotoxicity is a known complication following pediatric heart transplantation.
- Renal transplantation is a viable option for advanced cases of nephrotoxicity.
- Balancing renal protection with heart allograft survival is crucial in immunosuppressive strategies.
Purpose of the Study:
- To evaluate the outcomes of renal transplantation in patients who previously received a heart transplant.
- To assess the survival rates and effectiveness of kidney transplantation as a secondary procedure in pediatric heart transplant recipients.
Main Methods:
- A retrospective review of the Organ Procurement Transplant Network database.
- Analysis of data from October 1987 to January 2007, excluding combined heart-kidney transplants.
- Comparison with a matched cohort of heart transplant recipients without renal failure.
Main Results:
- 45 patients underwent renal transplantation after heart transplantation, with a mean age of 19.7 years.
- 78% of patients were on dialysis at the time of renal transplant; 54% received deceased donor kidneys.
- 1- and 5-year survival rates after renal transplantation were 91%, comparable to controls.
Conclusions:
- Renal transplantation following pediatric heart transplantation demonstrates favorable intermediate-term survival.
- This approach offers a successful solution for managing nephrotoxicity in this patient population.
Background:
Nephrotoxicity related to calcineurin inhibitors is a known complication after pediatric heart transplantation. Subsequent renal transplantation can be undertaken in advanced cases. An understanding of this strategy is important as many centers are advocating various renal-sparing immunosuppressive regimens-potentially at the cost of increasing heart allograft rejection.
Methods:
We reviewed the Organ Procurement Transplant Network database to determine the outcome for renal transplantation after pediatric heart transplantation between October 1987 and January 2007. Combined primary heart and kidney transplants were not included in the analysis.
Results:
During the period of study, 45 subjects underwent renal transplantation. The mean age at renal transplant was 19.7 +/- 6.1 years. Mean interval from primary heart transplantation to renal transplantation was 11.0 +/- 4.2 years. At time of renal transplantation, 35 subjects (78%) were receiving dialysis. The majority of subjects (54%) received a kidney from a deceased donor. Mean 1- and 5-year survival after renal transplantation was 91% at both time-points. This survival rate was not significantly different from that of a matched cohort of pediatric heart transplant recipients who did not require renal transplantation (hazard ratio 0.33, 95% confidence interval 0.08 to 1.35, p = 0.12).
Conclusions:
Intermediate-term survival for patients who undergo renal transplantation after previous pediatric heart transplantation is favorable.
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