Acute Kidney Injury Requiring Dialysis After Pediatric Heart Transplant
Amy R. Lipman
Division of Nephrology, Department of Medicine, Columbia University Vagelos College of Physicians & Surgeons, New York, USA
Columbia University Renal Epidemiology Group, New York, USA
Search for more papers by this authorIrene D. Lytrivi
Division of Cardiology, Department of Pediatrics, Columbia University Vagelos College of Physicians & Surgeons, New York, USA
Search for more papers by this authorHilda E. Fernandez
Division of Nephrology, Department of Medicine, Columbia University Vagelos College of Physicians & Surgeons, New York, USA
Division of Nephrology, Department of Pediatrics, Columbia University Vagelos College of Physicians & Surgeons, New York, USA
Search for more papers by this authorAine M. Lynch
Division of Cardiology, Department of Pediatrics, Columbia University Vagelos College of Physicians & Surgeons, New York, USA
Search for more papers by this authorMiko E. Yu
Division of Nephrology, Department of Medicine, Columbia University Vagelos College of Physicians & Surgeons, New York, USA
Columbia University Renal Epidemiology Group, New York, USA
Search for more papers by this authorJacob S. Stevens
Division of Nephrology, Department of Medicine, Columbia University Vagelos College of Physicians & Surgeons, New York, USA
Columbia University Renal Epidemiology Group, New York, USA
Search for more papers by this authorSumit Mohan
Division of Nephrology, Department of Medicine, Columbia University Vagelos College of Physicians & Surgeons, New York, USA
Columbia University Renal Epidemiology Group, New York, USA
Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA
Search for more papers by this authorCorresponding Author
Syed Ali Husain
Division of Nephrology, Department of Medicine, Columbia University Vagelos College of Physicians & Surgeons, New York, USA
Columbia University Renal Epidemiology Group, New York, USA
Correspondence:
Syed Ali Husain ([email protected])
Search for more papers by this authorAmy R. Lipman
Division of Nephrology, Department of Medicine, Columbia University Vagelos College of Physicians & Surgeons, New York, USA
Columbia University Renal Epidemiology Group, New York, USA
Search for more papers by this authorIrene D. Lytrivi
Division of Cardiology, Department of Pediatrics, Columbia University Vagelos College of Physicians & Surgeons, New York, USA
Search for more papers by this authorHilda E. Fernandez
Division of Nephrology, Department of Medicine, Columbia University Vagelos College of Physicians & Surgeons, New York, USA
Division of Nephrology, Department of Pediatrics, Columbia University Vagelos College of Physicians & Surgeons, New York, USA
Search for more papers by this authorAine M. Lynch
Division of Cardiology, Department of Pediatrics, Columbia University Vagelos College of Physicians & Surgeons, New York, USA
Search for more papers by this authorMiko E. Yu
Division of Nephrology, Department of Medicine, Columbia University Vagelos College of Physicians & Surgeons, New York, USA
Columbia University Renal Epidemiology Group, New York, USA
Search for more papers by this authorJacob S. Stevens
Division of Nephrology, Department of Medicine, Columbia University Vagelos College of Physicians & Surgeons, New York, USA
Columbia University Renal Epidemiology Group, New York, USA
Search for more papers by this authorSumit Mohan
Division of Nephrology, Department of Medicine, Columbia University Vagelos College of Physicians & Surgeons, New York, USA
Columbia University Renal Epidemiology Group, New York, USA
Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA
Search for more papers by this authorCorresponding Author
Syed Ali Husain
Division of Nephrology, Department of Medicine, Columbia University Vagelos College of Physicians & Surgeons, New York, USA
Columbia University Renal Epidemiology Group, New York, USA
Correspondence:
Syed Ali Husain ([email protected])
Search for more papers by this authorFunding: SAH was supported by a Nelson Family Faculty Development Award and NIDDK grant K23DK133729. The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
ABSTRACT
Background
Acute kidney injury (AKI) is a common complication of pediatric heart transplant, with a subset of patients developing severe AKI requiring dialysis (AKI-D). We aimed to identify the epidemiology, risk factors, and outcomes of postoperative AKI-D in pediatric heart transplant recipients.
Methods
We retrospectively identified all pediatric first-time, single-organ heart transplants at our institution from 2014 to 2022. Postoperative AKI was defined as AKI within 2 weeks of transplant. Unadjusted and adjusted logistic regression were used to identify characteristics associated with AKI-D, and unadjusted time-to-event analyses were used to determine the association between AKI-D and survival free of kidney failure.
Results
Among 177 patients included, 116 (66%) developed postoperative AKI of any stage, including 13 (7%) who developed AKI-D with median time from transplant to dialysis initiation of 6 days (IQR 3–13). In adjusted models, increased cardiopulmonary bypass time (OR 1.19, 95% CI 1.04–1.37, per 15 min increase in bypass time) and higher weight at transplant were associated with higher odds of AKI-D, whereas patient demographics and pretransplant kidney function were not associated with AKI-D. AKI-D was associated with greater mortality during initial hospitalization (46% vs. 1%, p < 0.001) and a lower rate of survival free of kidney failure.
Conclusions
The incidence of AKI-D after pediatric heart transplant was 7%, with extended cardiopulmonary bypass time associated with postoperative AKI-D even in adjusted models. Further research is needed to improve the prediction and management of AKI-D in this population.
Disclosure
S.M. receives grant funding from Kidney Transplant Collaborative and the NIH (DK114893, DK116066, DK126739, DK130058, and MD014161), and personal fees from Kidney International Reports, Sanofi and Health Services Advisory Group outside of the submitted work.
Conflicts of Interest
The authors have no financial conflicts of interest to disclose.
Open Research
Data Availability Statement
The data that support the findings of this study are available from the corresponding author upon reasonable request.
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