Abstract: TH-PO518
Outcomes of Simultaneous Heart-Kidney vs. Sequential Heart-Kidney Transplantation in Children
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
- Mahajan, Ruchi, University of Minnesota Twin Cities, Minneapolis, Minnesota, United States
- Evans, Michael David, University of Minnesota Twin Cities, Minneapolis, Minnesota, United States
- Kizilbash, Sarah J., University of Minnesota Twin Cities, Minneapolis, Minnesota, United States
Background
Heart transplant (HTx) recipients frequently require kidney transplantation for concomitant advanced chronic kidney disease. Data on simultaneous ( HTx and Kidney Transplant (KTx) at the same time) versus sequential {HTx performed before KTx} HTx and KTx in children are limited. Herein, we compare KTx outcomes between the two groups.
Methods
We used the Scientific Registry of Transplant Recipients (SRTR) to identify all pediatric (age < 21 years) Htx recipients who also received a KTx within 10 years of the HTx. We divided the study cohort into two: simultaneous heart/kidney and sequential heart/kidney recipients. We compared continuous and categorical variables using the Wilcoxon rank sum test and chi-square test. We compared patient and death-censored graft survival between simultaneous and sequential KTx recipients using the Cox regression, adjusting for age at the KTx, sex, race, pretransplant dialysis, donor type, and prior KTx. All analyses were performed in R, and a p-value of < 0.05 was considered statistically significant.
Results
Our analysis cohort included 165 recipients (79 for sequential and 86 for simultaneous). Table 1 is baseline characteristics of the cohort. We found no difference in patient survival (aHR: 0.97; 95% CI: 0.39, 2.41; p = 0.95) but better death-censored graft survival in sequential heart/kidney recipients compared with simultaneous heart/kidney recipients (aHR: 4.26; 95% CI: 1.21, 14.9; p = 0.02).
Conclusion
Pediatric HTx/KTx recipients who receive the KTx after their HTx have a better death-censored kidney allograft survival compared with those who receive KTx simultaneously with the heart transplant. Children with less significant kidney dysfunction at the time of HTx evaluation should be considered for a sequential heart/kidney transplant.
Baseline Characteristics of Patients undergoing Sequential versus Simultaneous Heart Kidney Transplantation.
| Demographic Characteristics | Sequential heart and kidney transplant N = 79 | Simultaneous heart and kidney transplant N = 86 | p Value |
| Median Age at kidney Tx (years) | 17.00 [13.00, 21.00] | 16.00 [12.00, 18.75] | 0.015 |
| Female | 35 (44.3) | 44 (51.2) | 0.47 |
| Race : Asian Black Multi Native White | 0 ( 0.0) 16 (20.3) 2 ( 2.5) 0 ( 0.0) 61 (77.2) | 4 ( 4.7) 35 ( 40.7) 0 ( 0.0) 1 ( 1.2) 46 ( 53.5) | 0.003 |
| Pretransplant dialysis :N Y | 13 (17.1) 63 (82.9) | 37 ( 44.6) 46 ( 55.4) | <0.001 |
| Donor Type : Deceased Living | 34 (43.0) 45 (56.0) | 86 (100.0) 0 | <0.001 |
| Delayed graft function (%): N Y | 72 (92.3) 6 (7.7) | 66(77.6) 19(22.4) | 0.017 |
| eGFR at Heart Transplant ( ml/min/1.73m2) Median (IQR) | 53.76 [37.16, 83.60] | 28.49 [17.18, 45.81] | <0.001 |
| Cause of ESKD (%): Focal Segmental Glomerulosclerosis (FSGS) Nephritis Hypoplasia/dysplasia/Agenesis Acute Tubular Necrosis Calcineurin Inhibitor Therapy Congenital Obstructive uropathy Other | 3 ( 3.8) 1 ( 1.3) 1 ( 1.3) 1 ( 1.3) 42 (53.2) 1 ( 1.3) 30 (37.9) | 9 ( 10.6) 3 ( 3.5) 3 ( 3.5) 2 ( 2.4) 20 ( 23.5) 0 ( 0.0) 49( 56.9) | 0.072 |