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Pediatric heart failure and worsening renal function: association with outcomes after heart transplantation

Satish K Rajagopal1, Vamsi V Yarlagadda, Ravi R Thiagarajan

  • 1Department of Cardiology, Children's Hospital Boston, Boston, MA 02115, USA. satish.rajagopal@cardio.chboston.org

The Journal of Heart and Lung Transplantation : the Official Publication of the International Society for Heart Transplantation
|October 22, 2011
PubMed

Insights

Worsening renal function (WRF) affects 15% of children awaiting heart transplants. This condition is linked to increased early mortality after transplantation but does not impact long-term survival.

Area of Science:

  • Pediatric Cardiology
  • Transplant Surgery
  • Nephrology

Background:

  • Renal function decline is observed in some pediatric patients awaiting heart transplantation.
  • Worsening renal function (WRF) may impact post-transplant outcomes.
  • The study investigates WRF's effect on survival after heart transplantation.

Purpose of the Study:

  • To assess the impact of WRF on post-heart transplantation outcomes.
  • To determine if waiting-list associated WRF affects survival after heart transplantation.

Main Methods:

  • Analysis of the Organ Procurement and Transplant Network database for children (<18 years) undergoing their first heart transplant (1999-2009).
  • Inclusion criteria: reported creatinine levels at listing and transplant, no renal replacement therapy at listing.
  • Logistic regression and log-rank analyses were used to assess WRF's independent effects on in-hospital mortality and post-discharge survival.

Main Results:

  • Of 2,216 children, 15% (334) experienced WRF.
  • Mild, moderate, and severe WRF were independently associated with increased in-hospital mortality (AORs 2.1, 2.7, 3.6, respectively).
  • WRF was not significantly associated with death after discharge (HR 1.2) during a median follow-up of 2.7 years.

Conclusions:

  • Worsening renal function affects 15% of pediatric heart transplant candidates.
  • WRF is independently associated with early post-transplant mortality.
  • WRF does not appear to affect late post-transplant survival.
Abstract

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