Renal injury and recovery in pediatric patients after ventricular assist device implantation and cardiac transplant

Seth A. Hollander, Ryan S. Cantor, Scott M. Sutherland, Devin A. Koehl, Elizabeth Pruitt, Nancy McDonald, James K. Kirklin, William J. Ravekes, Rebecca K Ameduri, Maryanne Chrisant, Timothy M. Hoffman, Irene D. Lytrivi, Jennifer Conway

Research output: Contribution to journalArticle

Abstract

Background: The use of ventricular assist devices (VADs) in children with heart failure may be of particular benefit to those with accompanying renal failure, as improved renal function is seen in some, but not all recipients. We hypothesized that persistent renal dysfunction at 7 days and/or 1 month after VAD implantation would predict chronic kidney disease (CKD) 1 year after heart transplantation (HT). Methods: Linkage analysis of all VAD patients enrolled in both the PEDIMACS and PHTS registries between 2012 and 2016. Persistent acute kidney injury (P-AKI), defined as a serum creatinine ≥1.5× baseline, was assessed at post-implant day 7. Estimated glomerular filtration rate (eGFR) was determined at implant, 30 days thereafter, and 12 months post-HT. Pre-implant eGFR, eGFR normalization (to ≥90 mL/min/1.73 m2), and P-AKI were used to predict post-HT CKD (eGFR <90 mL/min/1.73 m2). Results: The mean implant eGFR was 85.4 ± 46.5 mL/min/1.73 m2. P-AKI was present in 19/188 (10%). Mean eGFR at 1 month post-VAD implant was 131.1 ± 62.1 mL/min/1.73 m2, significantly increased above baseline (P < 0.001). At 1 year post-HT (n = 133), 60 (45%) had CKD. Lower pre-implant eGFR was associated with post-HT CKD (OR 0.99, CI: 0.97-0.99, P = 0.005); P-AKI was not (OR 0.96, CI: 0.3-3.0, P = 0.9). Failure to normalize renal function 30 days after implant was highly associated with CKD at 1 year post-transplant (OR 12.5, CI 2.8-55, P = 0.003). Conclusions: Renal function improves after VAD implantation. Lower pre-implant eGFR and failure to normalize renal function during the support period are risk factors for CKD development after HT.

Original languageEnglish (US)
Article numbere13477
JournalPediatric transplantation
Volume23
Issue number5
DOIs
StatePublished - Jan 1 2019

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Heart-Assist Devices
Glomerular Filtration Rate
Heart Transplantation
Chronic Renal Insufficiency
Pediatrics
Transplants
Kidney
Wounds and Injuries
Acute Kidney Injury
Renal Insufficiency
Registries
Creatinine
Heart Failure
Serum

Keywords

  • acute kidney injury
  • chronic kidney disease
  • heart
  • renal function
  • transplant
  • ventricular assist

PubMed: MeSH publication types

  • Journal Article

Cite this

Hollander, S. A., Cantor, R. S., Sutherland, S. M., Koehl, D. A., Pruitt, E., McDonald, N., ... Conway, J. (2019). Renal injury and recovery in pediatric patients after ventricular assist device implantation and cardiac transplant. Pediatric transplantation, 23(5), [e13477]. https://doi.org/10.1111/petr.13477

Renal injury and recovery in pediatric patients after ventricular assist device implantation and cardiac transplant. / Hollander, Seth A.; Cantor, Ryan S.; Sutherland, Scott M.; Koehl, Devin A.; Pruitt, Elizabeth; McDonald, Nancy; Kirklin, James K.; Ravekes, William J.; Ameduri, Rebecca K; Chrisant, Maryanne; Hoffman, Timothy M.; Lytrivi, Irene D.; Conway, Jennifer.

In: Pediatric transplantation, Vol. 23, No. 5, e13477, 01.01.2019.

Research output: Contribution to journalArticle

Hollander, SA, Cantor, RS, Sutherland, SM, Koehl, DA, Pruitt, E, McDonald, N, Kirklin, JK, Ravekes, WJ, Ameduri, RK, Chrisant, M, Hoffman, TM, Lytrivi, ID & Conway, J 2019, 'Renal injury and recovery in pediatric patients after ventricular assist device implantation and cardiac transplant', Pediatric transplantation, vol. 23, no. 5, e13477. https://doi.org/10.1111/petr.13477
Hollander, Seth A. ; Cantor, Ryan S. ; Sutherland, Scott M. ; Koehl, Devin A. ; Pruitt, Elizabeth ; McDonald, Nancy ; Kirklin, James K. ; Ravekes, William J. ; Ameduri, Rebecca K ; Chrisant, Maryanne ; Hoffman, Timothy M. ; Lytrivi, Irene D. ; Conway, Jennifer. / Renal injury and recovery in pediatric patients after ventricular assist device implantation and cardiac transplant. In: Pediatric transplantation. 2019 ; Vol. 23, No. 5.
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abstract = "Background: The use of ventricular assist devices (VADs) in children with heart failure may be of particular benefit to those with accompanying renal failure, as improved renal function is seen in some, but not all recipients. We hypothesized that persistent renal dysfunction at 7 days and/or 1 month after VAD implantation would predict chronic kidney disease (CKD) 1 year after heart transplantation (HT). Methods: Linkage analysis of all VAD patients enrolled in both the PEDIMACS and PHTS registries between 2012 and 2016. Persistent acute kidney injury (P-AKI), defined as a serum creatinine ≥1.5× baseline, was assessed at post-implant day 7. Estimated glomerular filtration rate (eGFR) was determined at implant, 30 days thereafter, and 12 months post-HT. Pre-implant eGFR, eGFR normalization (to ≥90 mL/min/1.73 m2), and P-AKI were used to predict post-HT CKD (eGFR <90 mL/min/1.73 m2). Results: The mean implant eGFR was 85.4 ± 46.5 mL/min/1.73 m2. P-AKI was present in 19/188 (10{\%}). Mean eGFR at 1 month post-VAD implant was 131.1 ± 62.1 mL/min/1.73 m2, significantly increased above baseline (P < 0.001). At 1 year post-HT (n = 133), 60 (45{\%}) had CKD. Lower pre-implant eGFR was associated with post-HT CKD (OR 0.99, CI: 0.97-0.99, P = 0.005); P-AKI was not (OR 0.96, CI: 0.3-3.0, P = 0.9). Failure to normalize renal function 30 days after implant was highly associated with CKD at 1 year post-transplant (OR 12.5, CI 2.8-55, P = 0.003). Conclusions: Renal function improves after VAD implantation. Lower pre-implant eGFR and failure to normalize renal function during the support period are risk factors for CKD development after HT.",
keywords = "acute kidney injury, chronic kidney disease, heart, renal function, transplant, ventricular assist",
author = "Hollander, {Seth A.} and Cantor, {Ryan S.} and Sutherland, {Scott M.} and Koehl, {Devin A.} and Elizabeth Pruitt and Nancy McDonald and Kirklin, {James K.} and Ravekes, {William J.} and Ameduri, {Rebecca K} and Maryanne Chrisant and Hoffman, {Timothy M.} and Lytrivi, {Irene D.} and Jennifer Conway",
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T1 - Renal injury and recovery in pediatric patients after ventricular assist device implantation and cardiac transplant

AU - Hollander, Seth A.

AU - Cantor, Ryan S.

AU - Sutherland, Scott M.

AU - Koehl, Devin A.

AU - Pruitt, Elizabeth

AU - McDonald, Nancy

AU - Kirklin, James K.

AU - Ravekes, William J.

AU - Ameduri, Rebecca K

AU - Chrisant, Maryanne

AU - Hoffman, Timothy M.

AU - Lytrivi, Irene D.

AU - Conway, Jennifer

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: The use of ventricular assist devices (VADs) in children with heart failure may be of particular benefit to those with accompanying renal failure, as improved renal function is seen in some, but not all recipients. We hypothesized that persistent renal dysfunction at 7 days and/or 1 month after VAD implantation would predict chronic kidney disease (CKD) 1 year after heart transplantation (HT). Methods: Linkage analysis of all VAD patients enrolled in both the PEDIMACS and PHTS registries between 2012 and 2016. Persistent acute kidney injury (P-AKI), defined as a serum creatinine ≥1.5× baseline, was assessed at post-implant day 7. Estimated glomerular filtration rate (eGFR) was determined at implant, 30 days thereafter, and 12 months post-HT. Pre-implant eGFR, eGFR normalization (to ≥90 mL/min/1.73 m2), and P-AKI were used to predict post-HT CKD (eGFR <90 mL/min/1.73 m2). Results: The mean implant eGFR was 85.4 ± 46.5 mL/min/1.73 m2. P-AKI was present in 19/188 (10%). Mean eGFR at 1 month post-VAD implant was 131.1 ± 62.1 mL/min/1.73 m2, significantly increased above baseline (P < 0.001). At 1 year post-HT (n = 133), 60 (45%) had CKD. Lower pre-implant eGFR was associated with post-HT CKD (OR 0.99, CI: 0.97-0.99, P = 0.005); P-AKI was not (OR 0.96, CI: 0.3-3.0, P = 0.9). Failure to normalize renal function 30 days after implant was highly associated with CKD at 1 year post-transplant (OR 12.5, CI 2.8-55, P = 0.003). Conclusions: Renal function improves after VAD implantation. Lower pre-implant eGFR and failure to normalize renal function during the support period are risk factors for CKD development after HT.

AB - Background: The use of ventricular assist devices (VADs) in children with heart failure may be of particular benefit to those with accompanying renal failure, as improved renal function is seen in some, but not all recipients. We hypothesized that persistent renal dysfunction at 7 days and/or 1 month after VAD implantation would predict chronic kidney disease (CKD) 1 year after heart transplantation (HT). Methods: Linkage analysis of all VAD patients enrolled in both the PEDIMACS and PHTS registries between 2012 and 2016. Persistent acute kidney injury (P-AKI), defined as a serum creatinine ≥1.5× baseline, was assessed at post-implant day 7. Estimated glomerular filtration rate (eGFR) was determined at implant, 30 days thereafter, and 12 months post-HT. Pre-implant eGFR, eGFR normalization (to ≥90 mL/min/1.73 m2), and P-AKI were used to predict post-HT CKD (eGFR <90 mL/min/1.73 m2). Results: The mean implant eGFR was 85.4 ± 46.5 mL/min/1.73 m2. P-AKI was present in 19/188 (10%). Mean eGFR at 1 month post-VAD implant was 131.1 ± 62.1 mL/min/1.73 m2, significantly increased above baseline (P < 0.001). At 1 year post-HT (n = 133), 60 (45%) had CKD. Lower pre-implant eGFR was associated with post-HT CKD (OR 0.99, CI: 0.97-0.99, P = 0.005); P-AKI was not (OR 0.96, CI: 0.3-3.0, P = 0.9). Failure to normalize renal function 30 days after implant was highly associated with CKD at 1 year post-transplant (OR 12.5, CI 2.8-55, P = 0.003). Conclusions: Renal function improves after VAD implantation. Lower pre-implant eGFR and failure to normalize renal function during the support period are risk factors for CKD development after HT.

KW - acute kidney injury

KW - chronic kidney disease

KW - heart

KW - renal function

KW - transplant

KW - ventricular assist

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