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Acute kidney injury after heart transplant in young children: risk factors and outcomes

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Abstract

Background

Critical illness following heart transplantation can include acute kidney injury (AKI). Study objectives were to define the epidemiology of, risk factors for, or impact on outcomes of AKI after pediatric heart transplant.

Methods

Using data from a prospective study of 66 young children, we evaluated: (1) post-operative AKI rate (by pediatric modified RIFLE criteria); (2) pre, intra, and early post-operative AKI risk factors using stepwise logistic regression (3) effect of AKI on short-term outcomes (ventilation and length of pediatric intensive care unit (PICU) stay) using stepwise multiple regression.

Results

AKI occurred in 73 % of children. Pre-transplant ventilation and higher baseline estimated creatinine clearance (eCCl) were independent risk factors for AKI. Pre-operative inotrope use was associated with reduced risk of AKI. Tacrolimus level emerged as important in multivariable risk prediction. Children with AKI had a longer duration of ventilation and length of pediatric intensive care unit (PICU) stay, with AKI being an independent predictor.

Conclusions

AKI was common after heart transplant and associated with more complicated early post-transplant course. Lower baseline eCCl was associated with lower incidence of AKI; this merits further investigation. The association of pre-operative inotropes with less AKI may reflect a pathophysiological mechanism or be a surrogate for clinical factors and management prior to transplant. Avoiding high tacrolimus levels may be a modifiable risk factor for AKI.

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Authors and Affiliations

  1. Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada

    Christine MacDonald, Gwen Y. Alton, Simon Urschel, Ari R. Joffe & Catherine J. Morgan

  2. Women and Children’s Health Research Institute, Edmonton, Alberta, Canada

    Simon Urschel, Ari R. Joffe & Catherine J. Morgan

  3. Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada

    Colleen Norris

  4. Room 4-557 Edmonton Clinic Health Academy, 11405-87 Avenue, Edmonton, Alberta, Canada, T6G 1C9

    Catherine J. Morgan

Authors
  1. Christine MacDonald
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  2. Colleen Norris
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  3. Gwen Y. Alton
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  4. Simon Urschel
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  5. Ari R. Joffe
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  6. Catherine J. Morgan
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on behalf of the Western Canadian Complex Pediatric Therapies Follow-Up Group

Corresponding author

Correspondence to Catherine J. Morgan.

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Conflict of interest

None of the authors have any conflict of interest, either real or perceived. Financial support: Registry and Follow-Up of Complex Pediatric Therapies Project, Alberta Health and Wellness, Stollery Children’s Hospital, and the Women and Children’s Health Research Institute. No funder had input into the design, data analysis, interpretation, or publication of this study.

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Ethics board approval was obtained and individual consent obtained from a parent or guardian.

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MacDonald, C., Norris, C., Alton, G.Y. et al. Acute kidney injury after heart transplant in young children: risk factors and outcomes. Pediatr Nephrol 31, 671–678 (2016). https://doi.org/10.1007/s00467-015-3252-x

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  • DOI: https://doi.org/10.1007/s00467-015-3252-x

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