Acute Kidney Injury Requiring Dialysis After Pediatric Heart Transplant

Area of Science:

• Pediatric Cardiology
• Nephrology
• Transplantation Medicine

Background:

• Acute kidney injury (AKI) is a frequent complication following pediatric heart transplantation.
• A subset of these patients progress to severe AKI requiring dialysis (AKI-D).
• Understanding AKI-D epidemiology, risk factors, and outcomes is critical for this vulnerable population.

Purpose of the Study:

• To determine the incidence of AKI-D in pediatric heart transplant recipients.
• To identify risk factors associated with the development of AKI-D.
• To evaluate the outcomes, including mortality and kidney failure-free survival, in patients with AKI-D.

Main Methods:

• Retrospective analysis of pediatric first-time, single-organ heart transplants between 2014 and 2022.
• Definition of postoperative AKI as occurring within two weeks of transplant.
• Logistic regression and time-to-event analyses were employed to identify risk factors and survival associations.

Main Results:

• Of 177 patients, 7% developed AKI-D, with a median time to dialysis of 6 days.
• Increased cardiopulmonary bypass time (OR 1.19) and higher transplant weight were associated with higher odds of AKI-D.
• AKI-D was significantly linked to increased in-hospital mortality (46% vs. 1%) and reduced kidney failure-free survival.

Conclusions:

• The incidence of AKI-D post-pediatric heart transplant is 7%.
• Extended cardiopulmonary bypass time is an independent risk factor for AKI-D.
• Further research is essential for improved prediction and management strategies for AKI-D in this cohort.