Kidney disease in children with heart or liver transplant

BackgroundThe development of acute kidney injury (AKI) has been associated with worse outcomes in children after heart transplantation. Our study compares the application of a cumulative six‐point Kidney Diseases Improving Global Outcomes (KDIGO) AKI scoring system, utilizing both creatinine and urine output criteria that we term as the AKI‐6 criteria, to traditional AKI staging as a predictor for clinical and renal outcomes in the pediatric heart transplant recipients.MethodsWe conducted a retrospective single‐center chart review on 155 pediatric patients who underwent heart transplantation from May 2014 to December 2021. The primary independent variable was the presence of severe AKI. Severe AKI by KDIGO was defined as Stage ≥2, whereas severe AKI by AKI‐6 was defined as cumulative scores ≥4 or Stage 3 AKI based on either KDIGO criterion alone. Primary outcomes included actuarial survival and renal dysfunction by 1‐year post‐transplant, defined as an estimated glomerular filtration rate <60 mL/min/1.73 m2.ResultsIn total, 140 (90%) patients developed AKI; 98 (63%) patients developed severe AKI by KDIGO, and 60 (39%) by AKI‐6. Severe AKI by AKI‐6 was associated with worse actuarial survival following heart transplantation compared with KDIGO (p = 0.01). Of the 143 patients with 1‐year creatinine data, 6 (11%) patients out of 54 with severe AKI by AKI‐6 had evidence of renal dysfunction (p = 0.01), compared with 6 (7%) patients out of 88 by KDIGO (p = 0.3).ConclusionsAKI‐6 scoring provides greater prognostic utility for actuarial survival and renal dysfunction by 1‐year post‐heart transplantation in pediatric patients than traditional KDIGO staging.

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

A novel acute kidney injury scoring system for renal and clinical outcomes in pediatric heart transplant patients

Daniel

Sutherland

Blinder

et al. 2023

“…In single-center studies, perioperative AKI has been reported in 67%-73% of pediatric heart recipients and 46%-67% of pediatric liver recipients. 28 Post-transplant, prolonged calcineurin inhibitor toxicity is a significant contributor to kidney dysfunction, particularly in the setting of chronically high tacrolimus trough levels. Tacrolimus decreases glomerular blood flow and stimulates production of the pro-fibrotic cytokine transforming growth factorβ, leading to renal interstitial fibrosis.…”

Section: Chroni C K Idne Y D Is E a S E In Non -Kidne Y Sotmentioning

confidence: 99%

Adult and late adolescent complications of pediatric solid organ transplantation

Byeman,

Harshman,

Engen

2024

BackgroundThere have been over 51 000 pediatric solid organ transplants since 1988 in the United States alone, leading to a growing population of long‐term survivors who face complications of childhood organ failure and long‐term immunosuppression.AimsThis is an educational review of existing literature.ResultsPediatric solid organ transplant recipients are at increased risk for risk for cardiovascular and kidney disease, skin cancers, and growth problems, though the severity of impact may vary by organ type. Pediatric recipients often are able to complete schooling, maintain a job, and form family and social networks in adulthood, though at somewhat lower rates than the general population, but face additional challenges related to neurocognitive deficits, mental health disorders, and discrimination.ConclusionsTransplant centers and research programs should expand their focus to include long‐term well‐being. Increased collaboration between pediatric and adult transplant specialists will be necessary to better understand and manage long‐term complications.

“…The effects of CKD in adult LT recipients include cardiovascular complications, which in turn aggravate renal impairment in the long term 3 . The effects of posttransplant CKD are even greater in children, as they also impact growth and development and put them at risk for future renal failure 4 . It is, therefore, important to prevent renal damage in these patients and monitor renal function during follow‐up in order to treat the possible underlying renal pathology and attenuate further demise.…”

Section: Introductionmentioning

confidence: 99%

A longitudinal study of long‐term renal outcome after pediatric liver transplantation in relation to CNI exposure

Vandewiele,

Herman,

van den Heuvel

et al. 2023

BackgroundChronic kidney disease (CKD) is reported in 20%–30% of children after liver transplantation (LT). One of the proposed underlying causes is the long‐term exposure to tacrolimus, a calcineurin inhibitor (CNI), which is the main immunosuppressive drug used after LT. Variation in tacrolimus absolute exposure and relative dose requirements are believed to be important risk factors for developing CNI‐associated nephrotoxicity.AimTo describe the long‐term renal outcome of pediatric LT recipients and determine the effects of tacrolimus exposure on renal outcome parameters.MethodsRetrospective single center study of renal function (GFR, proteinuria) and pharmacokinetic parameters (C0, AUC0–12h) obtained during annual follow‐up in children after liver transplantation, between 1998 and 2019. Relevant pharmacogenetic variants for tacrolimus disposition (CYP3A5 and ABCB1) were determined in recipients and donors. The evolution of individual renal function and tacrolimus exposure was evaluated using linear mixed models for repeated measurements.ResultsTwenty‐six children were included (mean follow‐up: 10.4 years (range 2–18.9)). Mean estimated GFR was 109.3 (SE: 7.4), vs. measured: 91.3 mL/min/1.73 m2 (SE: 6.3), which remained stable during follow‐up. CKD stage ≥2 was observed in 32.8% of the visits based on eGFR versus 50.0% on mGFR. CKD stage ≥3 was uncommon (4.1% and 6.2% resp.). Mean tacrolimus C0 was 5.3 ng/mL (SE: 2.5) with a AUC0–12h of 72.7 ng*h/mL (SE: 30.3), which demonstrated a small decrease during follow‐up. There was a negative correlation between C0 and mGFR (rS = −0.3; p < .001). We found no correlation between GFR and tacrolimus dose requirements ((ng/mL)/(mg/kg)) or pharmacogenetic background.ConclusionRenal function during long‐term follow‐up after pediatric LT remained stable for the majority of our cohort. However, mild CKD was relatively common, warranting follow‐up into adulthood. Although absolute tacrolimus exposure has a small depressing effect on concurrent GFR, there is no progressive deterioration of GFR due to long‐term exposure, dose requirements or genetic background under the current target levels. These findings should be confirmed in a larger sample set, ideally including data from multiple centers.