(1124) Predictors of Long-Term Renal Insufficiency in Repeat Pediatric Heart Transplants

• Published in: The Journal of heart and lung transplantation Vol. 42; no. 4; pp. S482 - S483
• Main Authors: Chan, M., Silveira, L., Patterson, D., Bock, M., Pietra, B., Everitt, M., Simpson, K., Miyamoto, S., Auerbach, S.
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01.04.2023
• ISSN: 1053-2498; 1557-3117
• DOI: 10.1016/j.healun.2023.02.1335

To evaluate for predictors of long-term renal function following repeat heart transplant (RT) in children and young adults. All RT at our center from 1995-2021 were reviewed. Estimated glomerular filtration rate (eGFR) was derived from CKiD U25 calculator using creatinine, measured at pre-RT, 1 week post-RT, 1-3 months, 6 months, and 12 months post-RT, and most recent follow-up. Associations between the following risk factors and development of chronic kidney disease, defined as stage 3b (CKD3b), were evaluated with linear regression: number of rejections prior to RT, pre-RT eGFR, 1-3 months post-RT eGFR, dialysis time, prior VAD/ECMO use, waitlist/bypass/ischemic time, time from RT, length of stay, and nephrotoxin use at RT. Receiving operating curves (ROC) were created to evaluate area under the curve (AUC) for development of CKD3b or higher. Time to event analysis was performed using Kaplan-Meier analysis and the log-rank test. RT was performed in 47 patients, with mean age of RT being 13 years old and half being male. Approximately 85% of patients identified as Caucasians. The reasons for RT were chronic rejection (40%) transplant vasculopathy (32%), graft failure (16%), acute rejection (6%), and other (6%). We found that eGFR 1-3 month post-transplant was statistically significant for the development of CKD3b (p = 0.013). Median follow up time was 2.5 years and the mean was 4 years. Figure 1a shows the survival based on an eGFR of 35mL/min/1.73m2 (p = 0.049). ROC analysis showed an area under the curve of 0.75 (Figure 1b). Sensitivity and specificity was 80% and 100%, respectively, for an eGFR of 35mL/min/1.73m2. Renal function at 1-3 months post-transplant is a long-term predictor of CKD3b in children, adolescence, and young adults undergoing RT. This finding suggests that early induction and maintenance immunosuppression may need to be modified.