Risk Factors for Late Renal Dysfunction after Pediatric Heart Transplantation: A Multi-institutional Study

摘要

Renal dysfunction is a major determinant of outcome after heart transplantation (HTx). Using a large, multi-institutional database we sought to identify factors associated with late renal dysfunction after pediatric HTx. All patients in the PHTS database with estimated glomerular filtration rate (eGFR) ≥60mL/min/1.73m² at one year post-HTx (n=812) were analyzed by Cox regression for association with risk factors for eGFR <60mL/min/1.73m² at >1 year after HTx. Freedom from late renal dysfunction was 71% and 57% at 5 and 10 years. Multivariate risk factors for late renal dysfunction were earlier era of HTx (HR 1.84; p<0.001), black race (HR 1.42; p=0.048), rejection with hemodynamic compromise in the first year after HTx (HR 1.74; p=0.038), and lowest quartile eGFR at one year post-HTx (HR 1.83; p<0.001). Renal function at HTx was not associated with onset of late renal dysfunction. Eleven patients (1.4%) required chronic dialysis and/or renal transplant during median follow-up of 4.1 years (1.5–12.6). Late renal dysfunction is common after pediatric HTx, with blacks at increased risk. Decreased eGFR at one year post-HTx, but not at HTx, predicts onset of late renal dysfunction. Future research on strategies to minimize late renal dysfunction after pediatric HTx may be of greatest benefit if focused on these subgroups.