Abstract: TH-PO068
AKI and Long-Term Renal Dysfunction After Nonrenal Solid Organ Transplant
Session Information
- AKI: Epidemiology, Risk Factors, Prevention - I
November 07, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 101 AKI: Epidemiology, Risk Factors, and Prevention
Authors
- Menon, Shina, Seattle Children's Hospital, Seattle, Washington, United States
- Pollack, Ari, Seattle Children's Hospital, Seattle, Washington, United States
- Sullivan, Erin M., Seattle Children's Hospital, Seattle, Washington, United States
- Smith, Jodi M., Children's Hospital & Regional Medical Center, Seattle, Washington, United States
Background
Solid-organ transplantation (SOT) is the treatment of choice for end-stage organ disease. Improved long term survival after SOT has uncovered chronic morbidity including chronic kidney disease (CKD). AKI is common after SOT and associated with increased morbidity, mortality, long term CKD
Methods
Retrospective cohort study using PEDSnet database. We studied rates of AKI and CKD after non renal SOT and relationship between the two. First-time heart (n=109), liver (n=112) transplant recipients <21 years age included. Perioperative AKI (pAKI) was AKI < 7days post transplant (txp); CKD was eGFR< 60 mL/min/1.73m2 for > 3 months. Incidence of CKD calculated using Product-limit Kaplan-Meier estimates & compared with log rank test. Effect of txp, time since txp, age, pAKI &successive AKI in first year post txp on the slope of eGFR assessed using multivariate linear regression
Results
pAKI seen in 50.3% (112/221). pAKI after liver txp was more common in older children and those with acute liver failure. Among heart txp, it was more common in younger patients. It was associated with longer ICU and hospital length of stays, lower eGFR at follow-up, and higher incidence of CKD (Figures 1 and 2).
Conclusion
pAKI is common after NRSOT- particularly after heart txp. Cumulative incidence of CKD is higher after heart txp than liver. Post liver txp, incidence of CKD is higher in those with pAKI than those without. pAKI and subsequent AKI episodes are both associated with significant decreases in eGFR during follow up. Patients who develop AKI need close monitoring for CKD and may benefit from kidney sparing immunosuppression.
Demographics & outcomes of liver & heart txp
CKD free survival and effect of variables on slope of eGFR post liver & heart txp