Pediatric Nephrology Fellow Ann & Robert H. Lurie Children's Hospital of Chicago Chicago, Illinois, United States
Background: Acute kidney injury (AKI) is common and an independent risk factor for prolonged hospitalization, development of CKD, and mortality in critically ill children undergoing cardiac surgery. AKI following heart transplantation (HTxp) has not been as well studied as other cardiac surgeries, especially in pediatrics. HTxp recipients have unique risk factors of prolonged mechanical circulatory support (ventricular assist devices), multiple surgeries requiring cardiopulmonary bypass, and nephrotoxic treatment regimens pre- and post- HTxp including diuretics and immunosuppression. Objective: Our study aims to address this knowledge-gap by describing rates of AKI following HTxp in both those with and without pre-operative VAD, as well as perform multivariate analysis to determine significant associated risk factors. Design/Methods: IRB was approved through Lurie Children's Hospital. We performed an observational, retrospective study with inclusion criteria: received HTxp between 2016-2021, age < 18 years at time of HTxp, and had at least 1 creatinine (Cr) in the first 7 postoperative days. GFR was estimated using bedside Schwartz equation. Baseline Cr was lowest value in one month prior to HTxp. AKI stages were defined by KDIGO creatinine criteria. Data was pulled through the EMR and Cardioaccess. Primary outcome was incidence of AKI in the first week following HTxp. 140 HTxp were performed and 43 (31%) had pre-operative VAD. Data has been analyzed for the VAD- HTxp subgroup. For this sub-group, mean pre-HTxp GFR was 142 mL/min/1.73m2; 11% (5/43) patients had CKD not requiring dialysis and 4.7% (2/43) were on dialysis. During the first 7 post-operative days, 74.42% (32/43) developed any AKI and 48.84% (21/43) developed severe AKI (stage 2-3); 16.27% (7/43) required dialysis. This is a higher incidence of AKI than previously published reports of pediatric cardiac surgeries. There is ongoing analyses to describe the incidence of AKI in the non-VAD HTxp (n=97). We will compare renal outcomes between subgroups. We anticipate the final work to be completed by January 2024.
