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Kidney Week

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 CharacteristicsSequential 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
Female35 (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