Pediatric Resident New York-Presbyterian Morgan Stanley Children's Hospital New York, New York, United States
Background: Pediatric heart transplant (OHT) recipients are at increased risk of acute kidney injury (AKI) and chronic kidney disease (CKD), and the number of children who progress from AKI to CKD after heart transplant surgery is often underestimated. The occurrence of AKI within three months of non-kidney solid organ transplantation has been associated with a higher risk of CKD. Proteinuria and hypertension (HTN) after transplant are known risk factors for CKD progression in the adult literature. Our study aims to identify whether HTN and proteinuria are risk factors for CKD in the OHT population. Objective: To identify whether HTN and proteinuria are risk factors for CKD in the OHT population Design/Methods: This is a retrospective chart review of peds OHT between 2/1/09 and 12/31/21 at NYP- Morgan Stanley Children’s Hospital of New York. Subjects who died, transferred care, or were lost to follow up within one year of OHT were excluded. Demographic and clinical data were extracted. Patients who developed AKI within three months of OHT, and patients with CKD at one, three and five years after OHT were identified. Estimated glomerular filtration rate (eGFR) using Modified Schwartz formula, as well as the presence of proteinuria and HTN were assessed at one year, three years and five years post-OHT. Descriptive statistics are reported, and t-test and chi-2 tests were performed to identify significant differences between patients with and without AKI within 3 months post-OHT. Results: Among 182 patients (mean age 8.3 ± 6 yrs, 57% female, 58% white, 17% Hispanic), 60 (33%) developed AKI within three months post-OHT. Patients w/ AKI were older at OHT (10.8 v 7.1 yrs, p=0.0001). Patients w/ AKI had a lower baseline eGFR ml/min/1.73m2 (121 vs 150) as well as a lower eGFR at one (89 vs 113), three- (88 vs 108) and five-yrs (88 vs 104) post-OHT (all p< 0.05). HTN was more common in patients w/ AKI post-OHT (37% vs 24%, p=0.06) though not significantly different. Patients w/ AKI were not more likely to develop proteinuria after transplantation (p>0.05), however not all OHT patients were routinely screened. CKD Stage 2 or higher developed in 54 patients (29.6%) at 5 years post-OHT in this study. HTN and proteinuria were not found to be associated with CKD stage.
Conclusion(s): AKI within three months of OHT was found to be associated with a lower GFR pre- and 1, 3 and 5 years post-OHT. Although not statistically significant, HTN and proteinuria were more common among those who had AKI. These data suggest that increased screening for proteinuria post-OHT may improve identification of patients at risk for CKD.
