Abstract 20393: End Stage Renal Disease After Pediatric Heart Transplantation: A 25-Year National Cohort Study
Background: End stage renal disease (ESRD) is a known complication after heart transplant (HTx); however risk factors associated with ESRD are not well elucidated. The objectives of this study were to determine the time course, risk factors, and outcome associated with ESRD.
Methods: Scientific Registry of Transplant Recipients data was linked to the US Renal Data System to identify patients (≤ 18 years) who underwent HTx (1989-2013). Multi-organ transplant were excluded. Associated risk factors and time course for ESRD (defined: chronic dialysis, wait listed for, and or kidney transplant [KTx]) were assessed using Cox regression analysis. Subjects that did not have an ESRD event were censored at death, lost to follow up, or December 31, 2013, whichever occurred earliest. P < 0.05 was significant.
Results: The final study cohort included 6702 HTx recipients. During a median follow up of 4.5 years ([IQR, 1.3 - 9.5], [range 0 - 24.7), 162 (2.4 %) patients developed ESRD. The actuarial risk of developing ESRD 5, 10 and 20 years post HTx were 0.3, 1.9, and 10.3% respectively (Fig. 1). Of the various risk factors analyzed only African American (AA) race was found to be significant (0.04) on univariate analysis. Age at HTx (<1, 1 - <10, 10 - 18 years) was not a risk factor for ESRD (P=0.2). Fifty patients (30.9%) with ESRD died after a median follow up of 3.8 years (IQR [2.1, 8.3]). The mortality in those who developed ESRD was 10% higher than those without ESRD (P = 0.01). Those who remained on chronic dialysis until death or end of follow had significantly higher risk of mortality compared to those who received KTx (P <0.0001), (Fig. 2).
Conclusions: ESRD is an important complication after HTx that generally begins 10 year post HTx. The risk significantly increases over next decade. AA race is the only other risk factor associated with ESRD. Post HTx ESRD strongly predicts mortality particularly in those who remain on chronic dialysis whereas KTx is protective.
Author Disclosures: S. Choudhry: Research Grant; Modest; This publication was funded by the Washington University Institute of Clinical and Translational Sciences which is, in part, supported by the NIH/National Center for Advancing Translational Sciences. C.D. Castleberry: None. V.R. Dharnidharka: None. C. Goss: None. K.E. Simpson: None. K. Schechtman: None. C.E. Canter: None.
- © 2016 by American Heart Association, Inc.