Related Experiment Video
Updated: Nov 21, 2025
Robot-Assisted Kidney Transplantation
Published on: July 19, 2021
Using kinetic eGFR to identify acute kidney injury risk in children undergoing cardiac transplantation
Minnie N Dasgupta1, Maria E Montez-Rath2, Seth A Hollander3
1Department of Pediatrics, Stanford University, Palo Alto, CA, USA. mdasgupta@stanford.edu.
Insights
Acute kidney injury (AKI) is common in pediatric heart transplant patients. Kinetic glomerular filtration rate (kGFR) moderately identifies AKI risk, offering a new method for early detection and prevention in this vulnerable population.
Area of Science:
- Pediatric Nephrology
- Transplantation Medicine
- Critical Care Medicine
Background:
- Acute kidney injury (AKI) is a frequent complication after pediatric cardiac transplantation, with no specific treatments available.
- Current strategies for AKI in this population focus on early identification and prevention.
- Kinetic glomerular filtration rate (kGFR) is a tool for assessing renal function in non-steady states, previously studied in adults but not in children.
Purpose of the Study:
- To examine the incidence of AKI in pediatric heart transplant recipients.
- To evaluate the ability of kGFR to identify AKI risk in this patient cohort.
- To explore kGFR as a potential novel risk stratification technique for AKI.
Main Methods:
- A retrospective study included 175 pediatric patients (<21 years) undergoing cardiac transplantation between 2007-2017.
- Two calculations of kGFR were performed: kGFR1 (pre-operative and immediate post-operative creatinine) and kGFR2 (first two post-operative creatinines).
- AKI was defined using the Kidney Disease: Improving Global Outcomes (KDIGO) criteria.
Main Results:
- A high incidence of AKI (75%) and severe AKI (45%) was observed, with 2.9% requiring dialysis.
- kGFR demonstrated a moderate association with post-operative AKI risk.
- The adjusted area under the curve (AUC) for kGFR1 and kGFR2 ranged from 0.65 to 0.72, indicating moderate predictive ability.
Conclusions:
- AKI is highly prevalent in children undergoing cardiac transplant, particularly within 24 hours post-surgery.
- kGFR shows moderate potential in identifying AKI risk, suggesting its utility as a novel risk stratification tool.
- This study is the first to formally investigate kGFR in a pediatric transplant population, highlighting its potential as an early AKI indicator.
Background:
Acute kidney injury (AKI) is common following pediatric cardiac transplantation. Since no treatments exist, strategies focus on early identification and prevention. Kinetic glomerular filtration rate (kGFR) was developed to assess renal function in the non-steady state. Although used to predict AKI in adults, kGFR has not been explored in children. Our study examines AKI and the ability of kGFR to identify AKI risk in pediatric heart transplant recipients.
Methods:
One hundred and seventy-five patients under 21 years who underwent cardiac transplantation at Lucile Packard Children's Hospital between September 2007-December 2017 were included. kGFR1 was calculated using pre-operative and immediate post-operative creatinines; kGFR2 was calculated with the first two post-operative creatinines. The primary outcome was AKI as defined by the Kidney Disease: Improving Global Outcomes criteria.
Results:
One hundred and thirty-one (75%) and 78 (45%) patients developed AKI and severe AKI, respectively; 5 (2.9%) required dialysis. kGFR was moderately associated with post-operative AKI risk. The adjusted area under the curve (AUC) for kGFR1 was 0.72 (discovery) and 0.65 (validation). The AUC for kGFR2 was 0.72 (discovery) and 0.68 (validation).
Conclusions:
AKI is pervasive in children undergoing cardiac transplant, particularly in the 24 h after surgery. kGFR moderately identifies AKI risk and may represent a novel risk stratification technique.
Impact:
Our research suggests that kGFR, a dynamic assessment of renal function that uses readily available laboratory values, can moderately identify AKI risk in children undergoing cardiac transplantation. Current published studies on kGFR are in adult populations; this study represents the first formal study of kGFR in a pediatric population. kGFR may serve as an early AKI indicator, allowing providers to implement preventative strategies sooner in a patient's clinical course.
Related Concept Videos
01:28Kidney Transplant I: Introduction
01:30Acute Kidney Injury IV: Diagnostic Studies and Prevention
01:22Acute Kidney Injury I: Introduction
01:26Kidney Transplant II: Surgical Procedure
01:29Acute Kidney Injury II: Pathophysiology
01:28Drug Dosing in Renal Diseases: Estimation of Glomerular Filtration Rate Based on Serum Creatinine Concentration