Abstract 1674: Renal Transplantation Following Previous Pediatric Heart Transplantation
Nephrotoxicity related to calcineurin inhibitors is a known complication following pediatric heart transplantation (tx). Subsequent renal tx can be undertaken in advanced cases, though the outcomes of this approach are poorly characterized. An understanding of the results for renal tx following prior pediatric heart tx is of great importance as many centers are advocating various renal-sparing immunosuppression regimens–potentially at the cost of heart allograft rejection.
Methods: In this study we reviewed the Organ Procurement Transplant Network database to determine the outcome for renal tx following prior pediatric heart tx. All subjects underwent pediatric heart tx and subsequent renal tx between 1/1/87 & 1/17/07. Subjects who underwent a primary combined heart/renal tx were not included.
Results: During the study period 44 subjects underwent renal tx, of these 5 underwent renal tx at the time of cardiac retransplantation for combined heart graft failure and renal insufficiency. The mean age at renal tx was 19.7±6.1 yrs. Mean duration from primary heart tx to renal tx was 10.8±4.4 yrs. At time of renal tx, 32 subjects (73%) were receiving dialysis. Hemodialysis was employed for 22/32 (69%) and periotneal dialysis for 10/32 (31%). The mean pre-tx serum creatinine was 6.4±3.9 mg/dl. The majority of subjects (57%) received kidney from a deceased donor. Two subjects received a second renal tx due to graft failure. The mean 1 and 5 yr patient survival following renal tx was 91% and 91%.
Conclusions. The outcome for patients who undergo renal tx following previous pediatric heart transplantation is excellent. While methods to reduce nephrotoxicity related to immunosuppressants should be explored, the favorable outcome following renal tx suggests that protection of the heart allograft should not be sacrificed in efforts to prevent renal damage.