Choudhry S, et al. - This study aimed to assess the prevalence, risk factors, and outcomes associated with end stage renal disease (ESRD) after pediatric-heart transplant (HTx). Findings suggest that in HTx survivors, ESRD after pediatric-HTx was more prevalent than documented by a transplant database alone. Development of a number of factors at or after HTx increased the risk for developing ESRD. In post HTx ESRD, use of kidney transplantation (KTx) seemed associated with improved survival.

Methods

• Using direct identifiers, researchers linked Scientific Registry of Transplant Recipients data to the United States Renal Data System to identify patients (≤18 years) who underwent primary HTx between 1989 and 2013.
• Analysis of risk factors for ESRD and death was performed using Cox-regression analysis.

Results

• About 25% additional HTx patients who developed ESRD were identified combining the above two databases; these were not captured by either database alone.
• 276/6901 (4%) patients developed ESRD during a median follow up of 11.8 years.
• Observations suggested that the actuarial risk of developing ESRD 10 and 20 years post-HTx were 3, and 16%.
• Significant risk factors for ESRD development included age at HTx >1 year, African-American race, year of HTx<2000, hypertension, diabetes-mellitus, heart re-transplant, acute dialysis, graft failure, and hospitalized infection.
• Higher risk of mortality was observed for those who remained on chronic dialysis in comparison to those who received KTx (Hazard ratio 31.4, 95% CI [20.8, 48.4], P<0.0001).