Related Experiment Video
Updated: Jun 10, 2025
A Pre-Clinical Porcine Model of Orthotopic Heart Transplantation
Published on: April 27, 2019
Longitudinal Changes in Estimated Glomerular Filtration Rate Following Repeat Heart Transplant in Children and Young
Melvin Chan1, Lori Silveira2, Daniel J Patterson3
1Pediatrics, Division of Nephrology, University of Colorado Denver, Anschutz Medical Campus, and Children's Hospital Colorado, Aurora, Colorado, USA.
Insights
Chronic kidney disease (CKD) is common after heart transplantation (HT). This study found that female sex and multiple acute kidney injuries (AKI) increase CKD risk post-repeat HT (RT).
Area of Science:
- Nephrology
- Cardiology
- Transplantation Medicine
Background:
- Chronic kidney disease (CKD) is a frequent complication following heart transplantation (HT).
- Limited research exists on longitudinal changes in estimated glomerular filtration rate (eGFR) after repeat heart transplantation (RT).
- Identifying risk factors for CKD stage 3 (CKD3) post-RT is crucial for patient management.
Purpose of the Study:
- To analyze longitudinal changes in eGFR after first-time (FT) and repeat heart transplantation (RT).
- To identify risk factors associated with the presence of CKD3 after RT.
Main Methods:
- Matched cohort study comparing first-time HT recipients (FT) with repeat HT recipients (RT).
- eGFR calculated using the CKiD-U25 formula; mixed effects models analyzed eGFR changes.
- Logistic regression and survival analysis identified risk factors for CKD3 post-RT.
Main Results:
- Mean eGFR showed no significant change over 6 years in either FT or RT groups.
- 73% of RT recipients with pre-existing CKD3 improved to CKD2 or lower within 2 years.
- Female sex (OR 17.5) and >2 acute kidney injuries (AKI) (OR 1.77) were significant risk factors for CKD3 post-RT.
Conclusions:
- Female sex and multiple AKIs between transplants are key risk factors for CKD3 post-RT.
- This study provides valuable data on long-term eGFR changes and CKD risk after repeat HT.
Background:
Chronic kidney disease (CKD) is common after heart transplantation (HT). There are scarce studies looking at longitudinal changes in estimated glomerular filtration rate (eGFR) after repeat HT (RT) and risk factors for the presence of CKD3 post-RT.
Methods:
First-time HT recipients (FT) were matched with RT, based on age at transplant, sex, race, and transplant era. eGFR was derived from CKiD-U25 formula using creatinine. Changes in eGFR were measured within and between patients using a mixed effects model. Logistic regression and survival analysis were performed to identify significant risk factors for CKD3 presence post-RT.
Results:
The unmatched cohort included 393 HT recipients and 47 RT. 29 patients in both groups with at least 2 years of follow-up data underwent matching. Over 6 years, the mean eGFR for FT and RT did not significantly change overtime. For those with CKD3 or higher prior to RT, 73% improved to CKD2 or lower at 2 years post-RT. Risk factors for CKD3 post-RT included female sex (OR 17.5 [1.7-181.9], p = 0.017) and greater than two acute kidney injuries (AKI) between FT and RT (OR 1.77 [1.06-2.95], p = 0.03). Approximately 50% of females and those with greater than two AKIs maintained or developed CKD3 at 7.5 and 3 years, respectively.
Conclusion:
This study provides data on longitudinal changes in eGFR over 6 years and finds that female sex and repeat HT recipients with greater 2 AKIs between transplants are at greatest risk for CKD3 presence post-RT.
Related Concept Videos
01:28Kidney Transplant I: Introduction
01:29Acute Kidney Injury III: Clinical Manifestations
01:28Glomerular Filtration Rate and its Regulation
GFR regulation involves two primary intrinsic controls: the myogenic and tubuloglomerular feedback mechanisms.
The myogenic...
01:26Kidney Transplant II: Surgical Procedure
01:16Kidney Transplant III: Nursing Management
01:02Renal Drug Excretion: Glomerular Filtration
Drugs gain access to the kidney via the renal artery, which progressively branches off into afferent arterioles....