53 - Risk Factors for Chronic Kidney Disease Following Pediatric Heart Transplant

Poster Number: 53
Publication Number: 53.340

Ruchi Gupta Mahajan, Columbia University Vagelos College of Physicians and Surgeons, Fort Lee, NJ, United States; Irene D. Lytrivi, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States; Zhezhen Jin, Columbia University, New York, NY, United States; Justin K. Chen, NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, NY, United States; Amy C. Rothkopf, Program for Pediatric Heart Failure and Transplant, NEW YORK, NY, United States; Prakash Satwani, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States; Namrata G. Jain, Hackensack Meridian School of Medicine, Short Hills, NJ, United States

Background: Children undergoing heart transplantation are at increased risk for the development of acute kidney injury (AKI). Limited pediatric studies have assessed risk factors contributing to post transplantation AKI and the long-term development of CKD. We aimed to assess the incidence of AKI and evaluate risk factors for development of chronic kidney disease (CKD) in this population.

Objective: Identify risk factors for CKD following pediatric heart transplant

Design/Methods: A retrospective observational study of 232 heart transplant patients, from infancy to age 18 years, in the period 1/2009-1/2020 was performed with three year follow up post-transplant. KDIGO AKI and CKD grading criteria were used. Patients with an initial AKI episode were analysed 90 days, 1 year and 3 years from the time of AKI. The eGFR at the 90 day time point post AKI episode was termed RRI, if GFR satisfied KDIGO CKD staging 2-5. Risk factors for the development of CKD after an episode of AKI immediately post-transplant were analysed at 3 months, 1 year and 3 years post-transplant.

Results: The overall incidence of AKI was 43.1%. One patient was excluded from statistical analysis. 44.4% female. Mean age with AKI was 8.8 years +/- 5.7 years. The mean time to AKI development (including KDIGO stage 1-3) was 6.7 +/-14.9 days; the mean time to peak serum creatinine was 9.4 +/-19.1 days. Of the patients, stage 1 AKI compromised 26.5%, stage 2 38.8%, and stage 3 35.7%. 5% of patients went into transplant on continuous renal replacement therapy (CRRT) and 10% required CRRT post-transplant. Of the AKI subgroup 31.9% met our criteria for RRI at 3 months. Use of ECMO as bridge to transplant (p=0.045) and graft ischemic time >180 minutes (p < 0.005) conferred higher risk of developing RRI at 3 months. Incidence of CKD post heart transplant was 14.3% at 1 year which was significantly increased (p < 0.014) if the patient had AKI within 1 month pre-transplant. Only 65% of the patients were available for 3 year follow-up, 13% had died within 3 years and 22% had moved to another location. The incidence of CKD at 3 years was 10.8%. No significant association to any of the risk factors was found which could be due to the high mortality and loss to follow up.Conclusion(s): Estimated creatinine clearance 90 days after AKI may aid in evaluating those children at risk for CKD outcome 1 and 3 years post heart transplant. Close monitoring of ischemic time during transplant, preventing AKI before heart transplant, and close monitoring of those needing ECMO bridge may potentially decrease progression of AKI to CKD.
Modifiable Risk Factors for Chronic Kidney Disease Following Pediatric Heart TransplantCV nov 2021.pdf