Swati Choudhry1, Vikas R Dharnidharka1, Chesney D Castleberry1, Charles W Goss2, Kathleen E Simpson1, Kenneth B Schechtman2, Charles E Canter3. 1. Department of Pediatrics, Washington University in St. Louis School of Medicine, St. Louis, Missouri. 2. Department of Biostatistics, Washington University in St. Louis School of Medicine, St. Louis, Missouri. 3. Department of Pediatrics, Washington University in St. Louis School of Medicine, St. Louis, Missouri. Electronic address: canter@wustl.edu.
Abstract
BACKGROUND: End-stage renal disease (ESRD), defined as the need for chronic dialysis and/or kidney transplantation (KTx), is a known complication after heart transplant (HTx). However, factors associated with ESRD are not well elucidated. The objectives of this study were to determine the prevalence, risk factors, and outcomes associated with ESRD after pediatric HTx. METHODS: Scientific Registry of Transplant Recipients data were linked, using direct identifiers, to the United States Renal Data System to identify patients (aged ≤ 18 years) who underwent primary HTx between 1989 and 2013. Risk factors for ESRD and death were analyzed using Cox regression analysis. RESULTS: Combining the above 2 databases identified ~25% additional HTx patients who developed ESRD that were not captured by either database alone. During a median follow-up of 11.8 years, ESRD developed in 276 of 6,901 patients (4%). The actuarial risk of developing ESRD after HTx was 3% at 10 years and 16% at 20 years. Age at HTx > 1 year, African-American race, year of HTx before 2000, hypertension, diabetes mellitus, re-HTx, acute dialysis, graft failure, and hospitalized infection were significant risk factors for ESRD development. Those who remained on chronic dialysis had higher risk of death than those who received KTx (hazard ratio, 31.4; 95% confidence interval, 20.8-48.4; p < 0.0001). CONCLUSIONS: ESRD after pediatric HTx is more prevalent in HTx survivors than documented by a transplant database alone. A number of factors develop at or after HTx that increase the risk for developing ESRD. Use of KTx in post-HTx ESRD is associated with improved survival.
BACKGROUND:End-stage renal disease (ESRD), defined as the need for chronic dialysis and/or kidney transplantation (KTx), is a known complication after heart transplant (HTx). However, factors associated with ESRD are not well elucidated. The objectives of this study were to determine the prevalence, risk factors, and outcomes associated with ESRD after pediatric HTx. METHODS: Scientific Registry of Transplant Recipients data were linked, using direct identifiers, to the United States Renal Data System to identify patients (aged ≤ 18 years) who underwent primary HTx between 1989 and 2013. Risk factors for ESRD and death were analyzed using Cox regression analysis. RESULTS: Combining the above 2 databases identified ~25% additional HTxpatients who developed ESRD that were not captured by either database alone. During a median follow-up of 11.8 years, ESRD developed in 276 of 6,901 patients (4%). The actuarial risk of developing ESRD after HTx was 3% at 10 years and 16% at 20 years. Age at HTx > 1 year, African-American race, year of HTx before 2000, hypertension, diabetes mellitus, re-HTx, acute dialysis, graft failure, and hospitalized infection were significant risk factors for ESRD development. Those who remained on chronic dialysis had higher risk of death than those who received KTx (hazard ratio, 31.4; 95% confidence interval, 20.8-48.4; p < 0.0001). CONCLUSIONS:ESRD after pediatric HTx is more prevalent in HTx survivors than documented by a transplant database alone. A number of factors develop at or after HTx that increase the risk for developing ESRD. Use of KTx in post-HTxESRD is associated with improved survival.
Authors: Anne I Dipchand; Richard Kirk; Leah B Edwards; Anna Y Kucheryavaya; Christian Benden; Jason D Christie; Fabienne Dobbels; Lars H Lund; Axel O Rahmel; Roger D Yusen; Josef Stehlik Journal: J Heart Lung Transplant Date: 2013-10 Impact factor: 10.247
Authors: Tara Karamlou; Karl F Welke; D Michael McMullan; Gordon A Cohen; Jill Gelow; Frederick A Tibayan; James M Mudd; Matthew S Slater; Howard K Song Journal: J Thorac Cardiovasc Surg Date: 2013-10-31 Impact factor: 5.209
Authors: Oscar Kolsrud; Sven-Erik Ricksten; Erik Holmberg; Marie Felldin; Kristjan Karason; Ola Hammarsten; Ola Samuelsson; Göran Dellgren Journal: Nephrol Dial Transplant Date: 2015-09-26 Impact factor: 5.992
Authors: Caroline K Lee; Laura L Christensen; John C Magee; Akinlolu O Ojo; William E Harmon; Nancy D Bridges Journal: J Heart Lung Transplant Date: 2007-05 Impact factor: 10.247
Authors: Jill Savla; Kimberly Y Lin; Madhura Pradhan; Rebecca L Ruebner; Rachel S Rogers; Somaly S Haskins; Anjali T Owens; Peter Abt; J William Gaynor; Robert E Shaddy; Joseph W Rossano Journal: J Am Heart Assoc Date: 2015-12-11 Impact factor: 5.501
Authors: Joseph Bayne; Michael Francke; Elaine Ma; Geoffrey A Rubin; Uma Mahesh R Avula; Haajra Baksh; Raymond Givens; Elaine Y Wan Journal: J Racial Ethn Health Disparities Date: 2020-10-28