Abstract: TH-PO517
AKI in Pediatric Heart Transplant Patients with a Ventricular Assist Device (VAD)
Session Information
- Pediatric Nephrology - I
November 02, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Pediatric Nephrology
- 1900 Pediatric Nephrology
Authors
- Bartlett, Deirdre, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois, United States
- Penk, Jamie, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois, United States
- Madden, Brian, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois, United States
- Kula, Alexander J., Ann and 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 transplant (HTxp) has not been as well studied, and even less is known in patients bridged with ventricular assist device. The VAD population warrants further attention given unique risk factors of prolonged mechanical circulatory support, multiple surgeries requiring cardiopulmonary bypass, and nephrotoxic treatments pre- and post- HTxp including diuretics and immunosuppression. Our study aimed to address this knowledge-gap by describing rates of AKI following HTxp in VAD dependent pediatric patients at time of surgery.
Methods
We performed an observational, retrospective study. Included patients met the following criteria: received HTxp at our institution during the past 5 years, age <18 years, use of VAD at time of HTxp, and at least 1 creatinine value in the first 7 postoperative days. GFR estimated using bedside Schwartz equation. AKI stages defined by KDIGO creatinine criteria. Primary outcome was incidence of AKI in the first week following HTxp.
Results
Out of 140 HTxp performed, 43 (31%) met inclusion criteria. Mean pre-Txp GFR was 142 mL/min/1.73m2 . 11% (5/43) had CKD not requiring dialysis and 4.7% (2/43) were on dialysis entering transplant. During the first 7 post-operative days, 74.42% (32/43) developed any AKI, 48.84% (21/43) developed severe AKI (stage 2-3) and 16.27% (7/43) required dialysis. Multivariate analysis will be performed to determine significantly associated risk factors.
Conclusion
Our study demonstrates pediatric HTxp recipients with VADs may have a high burden of AKI and severe AKI. The incidence of AKI in our cohort was much higher compared to previously published rates in other pediatric cardiac surgeries. Kidney care may need to be prioritized in VAD patients following HTxp. We plan to work to identify modifiable risk factors for post-transplant AKI in VAD patients in ongoing research.