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Kidney disease in children with heart or liver transplant
Amrit Kirpalani1,2, Chia Wei Teoh1,2, Vicky Lee Ng2,3
1Division of Nephrology, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.
Insights
Children undergoing heart or liver transplants face higher risks of kidney disease due to underlying conditions and treatments. Early recognition and management of kidney injury are crucial for better outcomes in pediatric transplant patients.
Area of Science:
- Pediatric Nephrology
- Transplant Medicine
- Pediatric Critical Care
Background:
- Children with non-kidney solid organ transplants have an increased risk of kidney disease.
- Pre-existing conditions and treatments for heart or liver failure can impair kidney function.
- Kidney injury is common during and after pediatric solid organ transplantation.
Purpose of the Study:
- To provide an overview of kidney disease in children undergoing heart or liver transplantation.
- To highlight the risks and complications associated with kidney injury in this population.
- To offer guidance on monitoring, diagnosis, prevention, and management of kidney disease.
Main Methods:
- Literature review on kidney disease in pediatric solid organ transplant recipients.
- Analysis of risk factors for acute kidney injury (AKI) and chronic kidney disease (CKD).
- Discussion of short- and long-term post-transplant complications affecting kidney function.
Main Results:
- Pediatric heart and liver transplant recipients are at significant risk for AKI and CKD.
- Nephrotoxic medications, infections, and immunologic insults contribute to kidney damage.
- CKD can progress to kidney failure requiring replacement therapy (KFRT), increasing morbidity and mortality.
Conclusions:
- Close monitoring for kidney injury is essential in children post-heart or liver transplant.
- Proactive risk factor mitigation and timely management can improve kidney outcomes.
- Understanding and addressing kidney disease is critical for improving survival rates in pediatric transplant patients.
Abstract:
Over the past few decades, there has been increasing recognition of kidney disease in children with non-kidney solid organ transplantation. The risk of kidney disease in children undergoing heart or liver transplantation is higher than the general population as the underlying disease and its associated management may directly impair kidney function. Both heart and liver failures contribute to hypoperfusion and kidney ischemia before patients reach the point of transplant. The transplant surgery itself can often be complicated by acute kidney injury (AKI), which may be further exacerbated by a complicated postoperative course. In the short- and long-term post-transplant period, these children are at risk of acute illness, exposed to nephrotoxic medications, and susceptible to rare but severe infections and immunologic insults that may contribute to AKI and chronic kidney disease (CKD). In some, CKD can progress to kidney failure with replacement therapy (KFRT). CKD and KFRT are associated with increased morbidity and mortality in this patient population. Therefore, it is critical to monitor for and recognize the risk factors for kidney injury in this population and mitigate these risks. In this paper, the authors provide an overview of kidney disease pertaining to heart and liver transplantation in children with guidance on monitoring, diagnosis, prevention, and management.
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