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Kidney transplantation in children with decreased left ventricular systolic function: a Midwest Pediatric Nephrology
Sandeep K Riar1, Mark M Mitsnefes, Edward J Nehus
1Division of Pediatric Nephrology, University of Kansas Medical Center, Kansas City, KS, USA, sriar@kumc.edu.
Insights
Kidney transplantation can safely improve cardiac function in children with severe left ventricular (LV) systolic dysfunction. This study shows LV function normalized post-transplant, suggesting it is a viable option for these patients.
Area of Science:
- Pediatric Nephrology
- Cardiology
- Transplantation
Background:
- Left ventricular (LV) systolic dysfunction is a serious complication in pediatric chronic kidney disease, often linked to uremia and hypertension.
- Management strategies and post-kidney transplant outcomes for these children are not well-defined.
- Combined heart-kidney transplant or delayed kidney transplant are potential options, but risks are unclear.
Observation:
- A retrospective, multicenter study examined outcomes in children with severe, symptomatic cardiomyopathy undergoing kidney transplantation.
- Eleven pediatric patients on maintenance dialysis with LV systolic dysfunction received kidney transplants without simultaneous heart transplants.
- Nine patients had pre-transplant congestive heart failure.
Findings:
- No post-transplant complications were linked to underlying cardiac dysfunction.
- Left ventricular systolic function significantly improved in all patients post-transplant.
- Mean shortening fraction increased from 19.0% to 32.0% (p < 0.0001).
Implications:
- Kidney transplantation is a viable option for children with severe LV dysfunction on dialysis.
- Successful kidney transplantation can lead to recovery of cardiac function in pediatric CKD patients.
- These findings support considering kidney transplantation for improved cardiac outcomes in pediatric CKD.
Background:
Left ventricular (LV) systolic dysfunction is a relatively uncommon but serious complication of pediatric chronic kidney disease, and may be related to uremia and uncontrolled hypertension. There is limited information on the strategy for managing these children. In some cases, combined heart-kidney transplant may be considered or kidney transplant delayed until cardiac function improves. It is unknown whether these patients are at increased risk for poor outcomes after kidney transplantation.
Methods:
We conducted a retrospective, multicenter study on the outcomes of children with severe and symptomatic cardiomyopathy who underwent kidney transplantation.
Results:
Eleven patients receiving maintenance dialysis with systolic dysfunction underwent kidney transplantation without simultaneous heart transplant. Nine patients had congestive heart failure in the pre-transplant period. There were no identified complications post-transplant related to the underlying cardiac dysfunction. LV systolic function normalized in all patients and the mean shortening fraction increased from 19.0 ± 4.6 % to 32.0 ± 4.4 % (p < 0.0001).
Conclusions:
Kidney transplantation should be considered for children receiving maintenance dialysis with severe LV dysfunction.
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01:28Kidney Transplant I: Introduction
01:26Kidney Transplant II: Surgical Procedure
01:16Kidney Transplant III: Nursing Management